Pelvic inflammatory disease medical therapy: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{Pelvic inflammatory disease}} | {{Pelvic inflammatory disease}} | ||
{{CMG}};{{AE}} | {{CMG}}; {{AE}} {{MehdiP}} | ||
==Overview== | ==Overview== | ||
In order to decrease the risk of complications, treatment should be initiated as soon as the presumptive diagnosis has been made. Hospitalization may be necessary for patients who are [[pregnant]], [[Immunodeficiency|immunodeficient]], and those with severe disease. Combination therapy is recommended to increase anti microbial coverage. Follow up is necessary in all treated patients and partner screening is recommended. | |||
==Medical Therapy== | ==Medical Therapy== | ||
*Treatment should be initiated as soon as the presumptive diagnosis has been made to decrease the risk of complications.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref> | *Treatment should be initiated as soon as the presumptive diagnosis has been made to decrease the risk of complications.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref> | ||
*The long term prognosis is highly dependent on immediate appropriate antibiotic therapy. | *The long term prognosis is highly dependent on immediate appropriate [[antibiotic therapy]]. | ||
*Combination therapy is recommended to increase | *Combination therapy is recommended to increase antibacterial coverage. | ||
*Patients are usually treated as outpatients. | *Patients are usually treated as [[outpatients]]. | ||
Indications for hospital admission:<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref> | Indications for hospital admission include:<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref> | ||
*Surgical emergencies (e.g., [[appendicitis]]) cannot be excluded | *[[Surgical emergency|Surgical emergencies]] (e.g., [[appendicitis]]) cannot be excluded | ||
*[[Tubo-ovarian abscess]] | *[[Tubo-ovarian abscess]] | ||
*[[Pregnancy]] | *[[Pregnancy]] | ||
*Severe illness, [[nausea]] and [[vomiting]], or high fever | *Severe illness, [[nausea]] and [[vomiting]], or [[high fever]] | ||
*Unable to follow or tolerate an outpatient oral regimen | *Unable to follow or tolerate an outpatient oral regimen | ||
*No clinical response to oral antimicrobial therapy. | *No clinical response to [[Antimicrobial agent|oral antimicrobial therapy]]. | ||
===Antibiotic therapy=== | ===Antibiotic therapy=== | ||
====Parenteral treatment==== | ====Parenteral treatment==== | ||
*Parenteral therapy has more benefits than oral/intramuscular therapy.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref><ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref> | *[[Parenteral|Parenteral therapy]] has more benefits than oral/[[intramuscular]] therapy.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref><ref name="pmid27107781">{{cite journal |vauthors=Ford GW, Decker CF |title=Pelvic inflammatory disease |journal=Dis Mon |volume=62 |issue=8 |pages=301–5 |year=2016 |pmid=27107781 |doi=10.1016/j.disamonth.2016.03.015 |url=}}</ref><ref name="pmid25992748">{{cite journal |vauthors=Brunham RC, Gottlieb SL, Paavonen J |title=Pelvic inflammatory disease |journal=N. Engl. J. Med. |volume=372 |issue=21 |pages=2039–48 |year=2015 |pmid=25992748 |doi=10.1056/NEJMra1411426 |url=}}</ref> | ||
*Clinical experience should guide decisions regarding transition to oral therapy, which usually | *Clinical experience should guide decisions regarding the transition to oral therapy, which can usually be initiated within 24–48 hours of clinical improvement. | ||
| Line 47: | Line 46: | ||
:::::[[Clindamycin]] 900 mg IV every 8 hours | :::::[[Clindamycin]] 900 mg IV every 8 hours | ||
:::::::::'''PLUS''' | :::::::::'''PLUS''' | ||
:::::[[Gentamicin]] loading dose IV or IM (2 mg/kg), | :::::[[Gentamicin]] [[loading dose]] IV or IM (2 mg/kg), | ||
:::::followed by a maintenance dose (1.5 mg/kg) every 8 hours. | :::::followed by a [[maintenance dose]] (1.5 mg/kg) every 8 hours. | ||
:::::Single daily dosing (3–5 mg/kg) can be substituted | :::::Single daily dosing (3–5 mg/kg) can be substituted | ||
---- | ---- | ||
| Line 60: | Line 59: | ||
====Intramuscular/Oral Treatment==== | ====Intramuscular/Oral Treatment==== | ||
*Intramuscular/oral therapy can be considered for women with mild-to-moderately severe acute PID, because the clinical outcomes among women treated with these regimens are similar to those treated with intravenous therapy.<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref> | *[[Intramuscular]]/oral therapy can be considered for women with mild-to-moderately severe acute PID, because the clinical outcomes among women treated with these regimens are similar to those treated with [[intravenous therapy]].<ref name="pmid26042815">{{cite journal |vauthors=Workowski KA, Bolan GA |title=Sexually transmitted diseases treatment guidelines, 2015 |journal=MMWR Recomm Rep |volume=64 |issue=RR-03 |pages=1–137 |year=2015 |pmid=26042815 |doi= |url=}}</ref> | ||
*Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref> | *Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy.<ref name="pmid12015517">{{cite journal |vauthors=Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF |title=Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial |journal=Am. J. Obstet. Gynecol. |volume=186 |issue=5 |pages=929–37 |year=2002 |pmid=12015517 |doi= |url=}}</ref> | ||
| Line 70: | Line 69: | ||
|- | |- | ||
| style="padding: 7px 7px; background: #DCDCDC;" |'''Intramuscular/Oral''' | | style="padding: 7px 7px; background: #DCDCDC;" |'''Intramuscular/Oral''' | ||
| style="padding: 7px 7px; background: # | | style="padding: 7px 7px; background: #F5F5F5;" | | ||
Preferred: | Preferred: | ||
| Line 87: | Line 86: | ||
:::::[[Clindamycin]] 900 mg IV every 8 hours | :::::[[Clindamycin]] 900 mg IV every 8 hours | ||
:::::::::'''PLUS''' | :::::::::'''PLUS''' | ||
:::::[[Gentamicin]] loading dose IV or IM (2 mg/kg), | :::::[[Gentamicin]] [[loading dose]] IV or IM (2 mg/kg), | ||
:::::followed by a maintenance dose (1.5 mg/kg) every 8 hours. | :::::followed by a [[maintenance dose]] (1.5 mg/kg) every 8 hours. | ||
:::::Single daily dosing (3–5 mg/kg) can be substituted | :::::Single daily dosing (3–5 mg/kg) can be substituted | ||
---- | ---- | ||
| Line 102: | Line 101: | ||
==Follow-up== | ==Follow-up== | ||
*Patients should return for re-evaluation | *Patients should return for re-evaluation on the third day of [[Antimicrobials|antimicrobial therapy]] to evaluate the success of therapy. | ||
*Patients who do not improve within 3 days of therapy may require hospitalization, additional diagnostic tests, and surgical intervention. | *Patients who do not improve within 3 days of therapy may require hospitalization, additional diagnostic tests, and/or surgical intervention. | ||
*Women with documented [[chlamydial]] or [[Gonorrhea|gonococcal]] infections have a high rate of reinfection within 6 months of treatment. | *Women with documented [[chlamydial]] or [[Gonorrhea|gonococcal]] infections have a high rate of reinfection within 6 months of treatment. | ||
*Repeat testing of all women who have been diagnosed with [[chlamydia]] or [[gonorrhea]] is recommended | *Repeat testing of all women who have been diagnosed with [[chlamydia]] or [[gonorrhea]] is recommended between 3 and 6 months after treatment, regardless of whether their sexual partners were treated. | ||
==Treatment of Sexual Partners== | ==Treatment of Sexual Partners== | ||
*Male partners of women who have PID are often asymptomatic. | *Male partners of women who have PID are often asymptomatic. | ||
*Both symptomatic and asymptomatic sexual partners of patients with pelvic inflammatory disease should be also be evaluated and treated. | *Both symptomatic and asymptomatic sexual partners of patients with pelvic inflammatory disease should be also be evaluated and, if necessary, treated. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Gynecology]] | [[Category:Gynecology]] | ||
[[Category:Abdominal pain]] | [[Category:Abdominal pain]] | ||
[[Category:Sexually transmitted diseases]] | [[Category:Sexually transmitted diseases]] | ||
[[Category:Infectious Disease Project]] | [[Category:Infectious Disease Project]] | ||
[[Category:Emergency mdicine]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Infectious disease]] | |||
Latest revision as of 23:37, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Overview
In order to decrease the risk of complications, treatment should be initiated as soon as the presumptive diagnosis has been made. Hospitalization may be necessary for patients who are pregnant, immunodeficient, and those with severe disease. Combination therapy is recommended to increase anti microbial coverage. Follow up is necessary in all treated patients and partner screening is recommended.
Medical Therapy
- Treatment should be initiated as soon as the presumptive diagnosis has been made to decrease the risk of complications.[1]
- The long term prognosis is highly dependent on immediate appropriate antibiotic therapy.
- Combination therapy is recommended to increase antibacterial coverage.
- Patients are usually treated as outpatients.
Indications for hospital admission include:[2][3]
- Surgical emergencies (e.g., appendicitis) cannot be excluded
- Tubo-ovarian abscess
- Pregnancy
- Severe illness, nausea and vomiting, or high fever
- Unable to follow or tolerate an outpatient oral regimen
- No clinical response to oral antimicrobial therapy.
Antibiotic therapy
Parenteral treatment
- Parenteral therapy has more benefits than oral/intramuscular therapy.[2][4][3]
- Clinical experience should guide decisions regarding the transition to oral therapy, which can usually be initiated within 24–48 hours of clinical improvement.
| Rout of administration | Regimen |
|---|---|
| Parenteral |
Preferred:
Alternative:
|
Intramuscular/Oral Treatment
- Intramuscular/oral therapy can be considered for women with mild-to-moderately severe acute PID, because the clinical outcomes among women treated with these regimens are similar to those treated with intravenous therapy.[2]
- Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy.[1]
| Rout of administration | Regimen |
|---|---|
| Intramuscular/Oral |
Preferred:
Alternative:
|
Follow-up
- Patients should return for re-evaluation on the third day of antimicrobial therapy to evaluate the success of therapy.
- Patients who do not improve within 3 days of therapy may require hospitalization, additional diagnostic tests, and/or surgical intervention.
- Women with documented chlamydial or gonococcal infections have a high rate of reinfection within 6 months of treatment.
- Repeat testing of all women who have been diagnosed with chlamydia or gonorrhea is recommended between 3 and 6 months after treatment, regardless of whether their sexual partners were treated.
Treatment of Sexual Partners
- Male partners of women who have PID are often asymptomatic.
- Both symptomatic and asymptomatic sexual partners of patients with pelvic inflammatory disease should be also be evaluated and, if necessary, treated.
References
- ↑ 1.0 1.1 Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, Sondheimer SJ, Hendrix SL, Amortegui A, Trucco G, Songer T, Lave JR, Hillier SL, Bass DC, Kelsey SF (2002). "Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial". Am. J. Obstet. Gynecol. 186 (5): 929–37. PMID 12015517.
- ↑ 2.0 2.1 2.2 Workowski KA, Bolan GA (2015). "Sexually transmitted diseases treatment guidelines, 2015". MMWR Recomm Rep. 64 (RR-03): 1–137. PMID 26042815.
- ↑ 3.0 3.1 Brunham RC, Gottlieb SL, Paavonen J (2015). "Pelvic inflammatory disease". N. Engl. J. Med. 372 (21): 2039–48. doi:10.1056/NEJMra1411426. PMID 25992748.
- ↑ Ford GW, Decker CF (2016). "Pelvic inflammatory disease". Dis Mon. 62 (8): 301–5. doi:10.1016/j.disamonth.2016.03.015. PMID 27107781.