Regimens for Treatment of Pelvic Inflammatory Disease

Patient is an adolescent

 

MANAGEMENT

Most patients are treated as outpatients.

Few studies exist comparing, outpatient versus inpatient management.

  1. Criteria for hospitalization (2015 CDC) (Table 10-§) are as follows:

 

The diagnosis, is uncertain.

Pelvic abscess is suspected.

Patient is pregnant.

Patient is an adolescent.

Patient is HIV positive.

Severe illness, nausea, or vomiting precludes outpatient management.

Patient cannot tolerate outpatient regimens

Patient has failed to respond clinically to outpatient therapy.

Clinical follow-up within 72 hours of initiating antibiotic treatment cannot be arranged.

  1. Outpatient treatment

Regimen A

Ofloxacin, 400 mg PO, bid x 14 days, or

Levofloxacin, 500 mg PO, qd x 14 days

The above may be combined with the following:

Metronidazole, 500 mg PO, bid x 14 days, or

Doxycycline, 100 mg PO, bid x 10 to 14 days

Regimen B

(1)Ceftriaxone, 250 mg IM, single dose, or

(2)Cefoxitin, 2 g IM, single dose, and Pribenecid, 1 g PO, single dose, or

(3) Third-generation cephalosporin (e.g., ceftizoxime or cefotax­ime) plus doxycycline, 100 mg bid x 14 days, with or without metronidazole, 500 mg PO, bid x 14 days

Regimen A

Cefoxitin, 2 g IV, q6h, or

Cefotetan, 2 g IV, ql2h, plus

Doxycycline, 100 mg IV or PO, ql2h

 

 

 

Regimen B

Clindamycin, 900 mg IV, q8h, plus

Centamycin, loading dose IV or IM (2 mg/kg of body weight), followed by a maintenance dose (1.5 mg/kg) q8h

Regimen should be continued for at least 24 hours after substan­tial clinical improvement, after which doxycycline, 100 mg PO, two times a day, should be continued for a total of 14 days.

 

Regimen should be continued for at least 24 hours after substan­tial clinical improvement, after which doxycycline, 100 mg PO, two times a day, or clinda­mycin, 450 mg PO, four times a day, to complete a total of 14 days of therapy.

CDC, Centers for Disease Control and Prevention; IV, intravenously; PO, orally.

 

FOLLOW-UP

 

 

  1. Hospitalized patients receiving IV therapy should show significant clinical improvement characterized by defervescence, decreased abdominal tenderness, and decreased uterine, adnexal, and cervical motion tenderness within 3 to 5 days.
  2. If no clinical improvement occurs, further diagnostic workup is neces­sary, including possible surgical intervention.
  3. Clinical improvement for outpatient therapy should be observed within 72 hours.
  4. Evaluation and treatment of male sex partners is essential.
  5. Long-term sequelae of PID are as follows:
    1. Recurrent PID
    2. Chronic pelvic pain
    3. Ectopic pregnancy
    4. Infertility
  6. The risk of tubal infertility related to episodes of PID is as follows:
    1. First episode: 8%
    2. Second episode: 20%
    3. Third episode: 40%

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