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CompletedNCT02648698Updated Feb 7, 2022Results posted

RCT(Randomized Clinical Trial ) of Antibiotic Therapy in Chronic Endometritis

An interventional study of Antibiotics in Chronic Endometritis, sponsored by Fu Xing Hospital, Capital Medical University. Completed at 1 site in China. Open to female participants aged 18 Years to 50 Years. Per ClinicalTrials.gov, last updated 2022-02-07.

Sponsored by Fu Xing Hospital, Capital Medical University · Not applicable, Interventional, and Treatment

Phase
Not applicable
Study type
Interventional
Enrollment
120
Allocation
Randomized
Ages
18 Years to 50 Years
Sex
Female
01

Study summary

120 cases with a diagnosis of chronic endometritis, confirmed by the presence of plasma cells in endometrial biopsy sample identified by immunohistochemical staining using CD138 antibody, have been recruited. The subjects have been randomly divided into two groups, the experimental group have been given antibiotic (Levofloxacin and Tinidazole for 14 days) treatment, the control group did not receive any antibiotic. Initially it was planned for women in the control group to take placebo,but the organization was difficult, so it was changed prior to the start of the study to an open label study. A repeat endometrial biopsy sample have been obtained 2-4 weeks after completion of the antibiotic therapy to assess the response to treatment. The conversion rate will be compared between the two groups

Read the detailed description

This study will be carried out at the Hysteroscopy centre of the Fuxing Hospital, Capital Medical University ,Beijing, China. A total of 120 women with chronic endometritis who fulfilled the following inclusion criteria will be recruited:

  1. CD138 immunohistochemical staining of endometrial specimen showed presence of one or more plasma cells per 10HPF which confirmed chronic endometritis, according to published criteria.
  2. women who were pre-menopausal.
  3. no evidence of endometrial hyperplasia or malignancy or structural uterine pathology.
  4. agreement to have a second endometrial biopsy \~4 weeks after the initial endometrial biopsy.
  5. written informed consent obtained

Exclusion Criteria:

  1. women who received steroid hormone therapy within one month of recruitment.
  2. allergy or suspected allergy to the chosen antibiotic therapy.
  3. women who developed any concurrent infection and received any antibiotic therapy during the period of study other than the one prescribed according to the study protocol.

Power calculation: Assuming that the spontaneous CD138 conversion (from positive to negative ) rate is 25% and that the antibiotic therapy results in 60% conversion rate, the total number of subjects required in each arm of the RCT will be 37, accepting a Type I error of 0.05 and a Type II error of 0.1, and assuming a drop-out rate of 20%, 45 subjects will need to be recruited into each arm. Hence, a total of 90 subjects who fulfilled the inclusion criteria will be required.

Recruitment: Women have been recruited form the day case hysteroscopy unit of the Hysteroscopy center, Fuxing Hospital, Beijing, China. The Hysteroscopy center currently carries out \~600 day case hysteroscopy per month. In all cases, endometrial biopsy specimen will be obtained at the time of hysteroscopy for histological evaluation. Since 2013, all endometrial specimens have been routinely examined with the used of CD138 antibody to establish if there is evidence of chronic endometritis, in addition to routine histopathological examination. Previous audit showed that \~15% of subjects had positive staining for CD138 cells.We recruited the initial 132 subjects according to the inclusion and exclusion criteria succesfully from July 2016 to December 2018.

Randomization:Women who had histological confirmation of CE in an endometrial biopsy specimen and who fulfilled the inclusion criteria were randomized into the antibiotic group and control group in a 1:1 ratio using a computer-generated randomization list and sealed opaque envelopes prepared by the first author. The patients were not blinded to the antibiotic treatment. The pathologist who performed the histological evaluation was blinded to the treatment.

Antibiotic therapy: Women who were randomized to the treatment group were given oral Levofloxacin and Tinidazole daily for 14 days.

Women who were randomized to the control group did not receive any antibiotic. Staff Pharmacist dispense medication.

Consent: written informed consent will be obtained

Repeat endometrial biopsy \& histological evaluation: The repeat endometrial biopsy will be performed after completion of the the antibiotic therapy. Immunohistochemical study using CD138 antibody will be performed.

02

Conditions studied

  • Chronic Endometritis

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Keywords

  • chronic endometritis
  • CD138
  • antibiotic
  • conversion rate.
03

In context

Endometritis

53 studies on the registry are indexed under Endometritis; 9 are open to participants now.

This study's enrollment of 120 is below the median of 202 across 40 interventional studies indexed under Endometritis.

Browse Endometritis studies →

Lead sponsor

Fu Xing Hospital, Capital Medical University is the lead sponsor of 17 studies on the registry; 5 are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years to 50 Years
Sexes eligible
Female
Accepts healthy volunteers
No

Inclusion criteria

  1. CD138 immunohistochemical staining of endometrial specimen showed presence of one or more plasma cells per 10HPF which confirmed chronic endometritis, according to published criteria.
  2. women who were pre-menopausal.
  3. no evidence of endometrial hyperplasia or malignancy or structural uterine pathology.
  4. agreement to have a second endometrial biopsy \~4 weeks after the initial endometrial biopsy.
  5. written informed consent obtained

Exclusion criteria

Exclusion Criteria:

  1. women who received steroid hormone therapy within one month of recruitment.
  2. allergy or suspected allergy to the chosen antibiotic therapy.
  3. women who developed any concurrent infection and received any antibiotic therapy during the period of study other than the one prescribed according to the study protocol.
05

Study design

Phase
Not applicable
Primary purpose
Treatment
Allocation
Randomized
Intervention model
Parallel assignment
Masking
Single (Investigator)
Enrollment
120 participants (actual)

Study arms

  • Experimental
    Antibiotic group

    This group received antibiotic therapy

    Drug: Antibiotics

  • No intervention
    Control group

    This group did not receive antibiotic therapy

Interventions

  • DrugAntibiotics

    Levofloxacin Tab and Tinidazole Tab are combined in the antibiotic group

    Also known as: Levofloxacin and Tinidazole

06

What researchers measure

Primary outcomes

  1. The Conversion Rate of CE (From Positive to Negative)

    Subjects in antibiotic group underwent a second-look hysteroscopy and repeat endometrial biopsy for histopathological CD138 immunohistochemical examination 2-4 weeks after completion of antibiotic treatment and in the follicular phase of the following menstrual cycle. Subjects in control group underwent a second-look hysteroscopy and repeat endometrial biopsy for histopathological CD138 immunohistochemical examination \~4 weeks after recruitment in the follicular phase of the following menstrual cycle. The biopsies were graded as "negative" for CE if there was less than one plasma cell identified per 10 high-power fields (HPFs) and "positive" when there was one or more plasma cell identified per 10 HPFs. To compare the cure rate (From positive to negative) of CE in women who received antibiotic therapy (treatment group) with the spontaneous cure rate in those who did not receive antibiotic therapy (control group),

    Time frame: 1-6 months

07

Results

Posted Jun 4, 2020
Limitations and caveats
A possible limitation of our study is that patients were not blinded to the antibiotic treatment. A further limitation is the cure rate based on a repeat of test used to make the diagnosis, instead of pregnancy, miscarriage or live birth.

Participant flow

Participant flow — Overall Study
MilestoneAntibiotic GroupControl Group
Started6060
Completed5955
Not completed15
Withdrew: Protocol violation15

Outcome measures

PrimaryThe Conversion Rate of CE (From Positive to Negative)

Subjects in antibiotic group underwent a second-look hysteroscopy and repeat endometrial biopsy for histopathological CD138 immunohistochemical examination 2-4 weeks after completion of antibiotic treatment and in the follicular phase of the following menstrual cycle. Subjects in control group underwent a second-look hysteroscopy and repeat endometrial biopsy for histopathological CD138 immunohistochemical examination \~4 weeks after recruitment in the follicular phase of the following menstrual cycle. The biopsies were graded as "negative" for CE if there was less than one plasma cell identified per 10 high-power fields (HPFs) and "positive" when there was one or more plasma cell identified per 10 HPFs. To compare the cure rate (From positive to negative) of CE in women who received antibiotic therapy (treatment group) with the spontaneous cure rate in those who did not receive antibiotic therapy (control group),

Time frame:
1-6 months
Reported as:
Number · Percentage of participants
The Conversion Rate of CE (From Positive to Negative)
Percentage of participantsAntibiotic GroupControl Group
The Conversion Rate of CE (From Positive to Negative)89.8 (82.2 to 97.5)12.7 (3.9 to 21.5)

Adverse events

Collected over 6 months. Non-serious events are listed at a 0% frequency threshold.

Adverse event summary by group
GroupDeathsSeriousOther
Antibiotic Group0/59 (0%)0/59 (0%)0/59 (0%)
Control Group0/55 (0%)0/55 (0%)0/55 (0%)

Baseline characteristics

Age, Continuous
Age, Continuous(years)Antibiotic GroupControl GroupTotal
Mean31.86 ± 4.731.93 ± 4.831.89 ± 4.7
Sex: Female, Male
Sex: Female, Male(Participants)Antibiotic GroupControl GroupTotal
Female6060120
Male000
Race (NIH/OMB)
Race (NIH/OMB)(Participants)Antibiotic GroupControl GroupTotal
American Indian or Alaska Native000
Asian6060120
Native Hawaiian or Other Pacific Islander000
Black or African American000
White000
More than one race000
Unknown or Not Reported000
Region of Enrollment
Region of Enrollment(participants)Antibiotic GroupControl GroupTotal
China5955114
BMI
BMI(kg/m^2)Antibiotic GroupControl GroupTotal
Mean22.91 ± 3.422.28 ± 3.522.61 ± 3.4
Parity
Parity(events)Antibiotic GroupControl GroupTotal
Mean2.15 ± 0.92.15 ± 0.92.15 ± 0.9
Miscarriage
Miscarriage(events)Antibiotic GroupControl GroupTotal
Mean1.59 ± 1.01.93 ± 1.01.75 ± 1.0
08

Study locations

1 site
  • FuXing Hospital,Capital Medical University
    Beijing, Beijing 100038, China
09

References and documents

Publications

  • McQueen DB, Bernardi LA, Stephenson MD. Chronic endometritis in women with recurrent early pregnancy loss and/or fetal demise. Fertil Steril. 2014 Apr;101(4):1026-30. doi: 10.1016/j.fertnstert.2013.12.031. Epub 2014 Jan 23. PubMed 24462055 ↗
  • Cicinelli E, Matteo M, Tinelli R, Pinto V, Marinaccio M, Indraccolo U, De Ziegler D, Resta L. Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage as confirmed by improved pregnancy outcome after antibiotic treatment. Reprod Sci. 2014 May;21(5):640-7. doi: 10.1177/1933719113508817. Epub 2013 Oct 31. PubMed 24177713 ↗
  • Kitaya K. Prevalence of chronic endometritis in recurrent miscarriages. Fertil Steril. 2011 Mar 1;95(3):1156-8. doi: 10.1016/j.fertnstert.2010.09.061. Epub 2010 Oct 28. PubMed 21030015 ↗
  • Bayer-Garner IB, Nickell JA, Korourian S. Routine syndecan-1 immunohistochemistry aids in the diagnosis of chronic endometritis. Arch Pathol Lab Med. 2004 Sep;128(9):1000-3. doi: 10.5858/2004-128-1000-RSIAIT. PubMed 15335255 ↗
  • Kannar V, Lingaiah HK, Sunita V. Evaluation of endometrium for chronic endometritis by using syndecan-1 in abnormal uterine bleeding. J Lab Physicians. 2012 Jul;4(2):69-73. doi: 10.4103/0974-2727.105584. PubMed 23440678 ↗
  • Kitaya K, Yasuo T. Immunohistochemistrical and clinicopathological characterization of chronic endometritis. Am J Reprod Immunol. 2011 Nov;66(5):410-5. doi: 10.1111/j.1600-0897.2011.01051.x. Epub 2011 Jul 12. PubMed 21749546 ↗
  • Cicinelli E, Matteo M, Tinelli R, Lepera A, Alfonso R, Indraccolo U, Marrocchella S, Greco P, Resta L. Prevalence of chronic endometritis in repeated unexplained implantation failure and the IVF success rate after antibiotic therapy. Hum Reprod. 2015 Feb;30(2):323-30. doi: 10.1093/humrep/deu292. Epub 2014 Nov 10. PubMed 25385744 ↗
  • McQueen DB, Perfetto CO, Hazard FK, Lathi RB. Pregnancy outcomes in women with chronic endometritis and recurrent pregnancy loss. Fertil Steril. 2015 Oct;104(4):927-931. doi: 10.1016/j.fertnstert.2015.06.044. Epub 2015 Jul 21. PubMed 26207958 ↗
  • Song D, He Y, Wang Y, Liu Z, Xia E, Huang X, Xiao Y, Li TC. Impact of antibiotic therapy on the rate of negative test results for chronic endometritis: a prospective randomized control trial. Fertil Steril. 2021 Jun;115(6):1549-1556. doi: 10.1016/j.fertnstert.2020.12.019. Epub 2021 Feb 3. PubMed 33549312 ↗

Study documents

  • Protocol and statistical analysis plan · May 30, 2020

Documents are hosted by the registry — open the source record to download them.

Individual participant data

Plan to share: No

10

Updates

Tracking since Sep 25, 2026
No changes since tracking began. The registry record was last updated on Feb 7, 2022, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
11

Registry details

Key details

Study ID
NCT02648698
Lead sponsor
Fu Xing Hospital, Capital Medical University
Responsible party
Song Dongmei (Hysteroscopy Center, Fu Xing Hospital, Capital Medical University) — Principal investigator
First posted
Jan 7, 2016
Start date
Jan 10, 2016
Primary completion
Dec 15, 2018
Completion
Dec 15, 2018
Results posted
Jun 4, 2020
Last update
Feb 7, 2022

Study contacts

Dongmei Song, Master
principal investigator · FuXing Hospital,Capital Medical University
Enlan Xia, Master
study director · FuXing Hospital,Capital Medical University
Tinchiu Li, PhD
study chair · FuXing Hospital,Capital Medical University
Xiaoxia Peng, PhD
study director · Capital Medical University

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

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