Pelvic inflammatory disease medical therapy: Difference between revisions
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==Medical Therapy== | ==Medical Therapy== | ||
*Treatment should be initiated as soon as the presumptive diagnosis has been made to decrease the risk of complications. | *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 anti bacterial coverage. | *Combination therapy is recommended to increase anti bacterial coverage. | ||
*Patients are usually treated as outpatients. | *Patients are usually treated as outpatients. | ||
Indications for hospital admission: | 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> | ||
*Surgical emergencies (e.g., [[appendicitis]]) cannot be excluded | *Surgical emergencies (e.g., [[appendicitis]]) cannot be excluded | ||
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===Antibiotic therapy=== | ===Antibiotic therapy=== | ||
====Parenteral treatment==== | ====Parenteral treatment==== | ||
*Parenteral therapy has more benefits than oral/intramuscular therapy | *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> | ||
*Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24–48 hours of clinical improvement. | *Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24–48 hours of clinical improvement. | ||
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====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. | *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> | ||
Revision as of 17:13, 21 October 2016
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Pelvic inflammatory disease Microchapters |
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Differentiating Pelvic Inflammatory Disease from other Diseases |
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Pelvic inflammatory disease medical therapy On the Web |
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American Roentgen Ray Society Images of Pelvic inflammatory disease medical therapy |
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Risk calculators and risk factors for Pelvic inflammatory disease medical therapy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];Associate Editor(s)-in-Chief: :Seyedmahdi Pahlavani, M.D. [2]
Overview
Treatment should be initiated as soon as the presumptive diagnosis has been made to decrease the risk of complications. 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 anti bacterial coverage.
- Patients are usually treated as outpatients.
Indications for hospital admission:[2]
- 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]
- Clinical experience should guide decisions regarding transition to oral therapy, which usually can 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 at the third day of antimicrobial therapy to evaluate for the success of therapy.
- Patients who do not improve within 3 days of therapy may require hospitalization, additional diagnostic tests, and 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 3–6 months after treatment, regardless of whether their sex 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 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.