Pelvic inflammatory disease medical therapy: Difference between revisions
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;Shown below is a table summarizing the preferred and alternative empiric treatment for Pelvic inflammatory disease (includes [[salpingitis]], tubo-ovarian abscess and [[pelvic peritonitis]]). | ;Shown below is a table summarizing the preferred and alternative empiric treatment for Pelvic inflammatory disease (includes [[salpingitis]], tubo-ovarian abscess and [[pelvic peritonitis]]). | ||
Revision as of 15:10, 28 December 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Treatment depends on the cause and generally involves use of antibiotic therapy. If the patient has not improved within two to three days after beginning treatment with the antibiotics, they should return to the hospital for further treatment. Drugs should also be given orally and/or intravaneously to the patient while in the hospital to begin treatment immediately to increase the effectiveness of antibiotic treatment. Hospitalization may be necessary if Tubo-ovarian abscess, very ill, immunodeficient, pregnancy, incompetence, or because this or something else life threatening can not be ruled out. Treating partners for STD's is a very important part of treatment and prevention. Anyone with PID and partners of patients with PID since six months prior to diagnosis should be treated to prevent reinfection. Psychotherapy is highly recommended to women diagnosed with PID as the fear of redeveloping the disease after being cured may exist. It is important for a patient to communicate any issues and/or uncertainties they may have to a doctor, especially a specialist such as a gynecologist, and in doing so, to seek follow-up care.
Medical Therapy
PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.
Because of the difficulty in identifying organisms infecting the internal reproductive organs and because more than one organism may be responsible for an episode of PID, PID is usually treated with at least two antibiotics that are effective against a wide range of infectious agents. These antibiotics can be given by mouth or by injection. The symptoms may go away before the infection is cured. Even if symptoms go away, the woman should finish taking all of the prescribed medicine. This will help prevent the infection from returning. Women being treated for PID should be re-evaluated by their health care provider three days after starting treatment to be sure the antibiotics are working to cure the infection. In addition, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. Although sex partners may have no symptoms, they may still be infected with the organisms that can cause PID.
Hospitalization to treat PID may be recommended if the woman
(1) Is severely ill (e.g., nausea, vomiting, and high fever)
(2) Is pregnant
(3) Does not respond to or cannot take oral medication and needs intravenous antibiotics
(4) Has an abscess in the fallopian tube or ovary (tubo-ovarian abscess) or
(5) Needs to be monitored to be sure that her symptoms are not due to another condition that would require emergency surgery (e.g., appendicitis).
If symptoms continue or if an abscess does not go away, surgery may be needed.
Empiric Treatment
Treatment is usually started empirically because of the terrible complications.
Empiric treatment for PID should be initiated in sexually active young women and other women at risk for STDs if they are experiencing pelvic or lower abdominal pain, if no cause for the illness other than PID can be identified, and if one or more of the following minimum criteria are present on pelvic examination:
- cervical motion tenderness
or
- uterine tenderness
or
- adnexal tenderness.
- Shown below is a table summarizing the preferred and alternative empiric treatment for Pelvic inflammatory disease (includes salpingitis, tubo-ovarian abscess and pelvic peritonitis).
| Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment |
| All women with Pelvic inflammatory disease | N. gonorrhoeae
C. trachomatis Gardnerella spp. Ureaplasma urealyticum Anaerobes (Prevotella spp., B. fragilis) Gram negative rods Streptococci |
Cefotetan
2g IV Q12H + Doxycycline 100mg PO BID OR Azithromycin 1g PO once weekly OR Ertapenem 1g IV Q24H + Doxycycline 100mg PO BID OR Azithromycin 1g PO once weekly OR Pencillin allergy: Clindamycin 600-900 mg IV Q8H + Gentamicin 5 mg/kg IV once daily (doses should be rounded to the nearest 10 mg). Step-down therapy once patient is afebrile: Doxycycline 100mg PO BID + Clindamycin 450 mg PO QID OR Metronidazole 500 mg PO BID |
14 days |
Treatment of Partners
- All women diagnosed with acute PID should be offered HIV testing.
- Male partners of women who have PID often are asymptomatic.
- Sex partners (male or female) of patients who have PID should be examined and treated empirically for C. trachomatis and N. gonorrhoeae if they have had sexual contact with the patient during the 60 days preceding onset of symptoms in the patient, regardless of the pathogens isolated from the patient.