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Pelvic Inflammatory
Disease Medication
Updated: May 03, 2019
Author: Kristi A Tough DeSapri, MD; Chief Editor: Nicole W Karjane, MD more...

MEDICATION

Medication Summary
Treatment of pelvic inflammatory disease (PID) should include empirical broad-spectrum antibiotics
to cover the full complement of common causes. Antibiotics chosen should be effective against
Chlamydia trachomatis and Neisseria gonorrhoeae, as well as against gram-negative facultative
organisms, anaerobes, and streptococci. The Centers for Disease Control and Prevention (CDC)
has outlined antibiotic regimens for outpatient and inpatient treatment of PID.

Macrolides

Class Summary
Macrolides are a class of antibiotics discovered in the bacterium Streptomyces. These agents are
characterized by molecules made up of large-ring lactones. Many macrolides inhibit protein
biosynthesis.

Azithromycin (Zithromax, Zmax)

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Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and
blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to
arrest. Nucleic acid synthesis is not affected. This drug concentrates in phagocytes and fibroblasts,
as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in
phagocytes may contribute to drug distribution to inflamed tissues.

Azithromycin is used to treat mild-to-moderate microbial infections. Plasma concentrations are very
low, but tissue concentrations are much higher, giving the drug value in treating intracellular
organisms. Azithromycin has a long tissue half-life. Azithromycin is related to erythromycin. It is

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considered by many to be treatment of choice for C trachomatis genitourinary infection because it

may be administered as a single dose, which improves adherence to treatment.

Cephalosporins, 3rd Generation

Class Summary
Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are
derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell
wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P
resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity.
Third-generation cephalosporins are less active against gram-positive organisms then first-
generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and
Haemophilus influenzae.

Ceftriaxone (Rocephin)
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Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are

derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell
wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P
resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity.
Third-generation cephalosporins are less active against gram-positive organisms then first-
generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and
Haemophilus influenzae.

Cefotaxime (Claforan)
Cefotaxime is a third-generation cephalosporin with a broad gram-negative spectrum, lower
efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests
bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins, thereby in turn
inhibiting bacterial growth. Cefotaxime is used to treat bloodstream infection and gynecologic
infections caused by susceptible organisms.

Ceftizoxime (Cefizox)
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Ceftizoxime is a third-generation cephalosporin with broad-spectrum gram-negative activity. It has

lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It

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arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Its gram-negative

spectrum includes Moraxella catarrhalis. Dose selection depends on the severity of the infection
and the susceptibility of the organism.

Cephalosporins, 2nd Generation

Class Summary
Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are
derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell
wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P
resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity.
Compared with first-generation cephalosporins, second-generation agents have increased activity
against gram-negative bacteria and decreased activity against gram-positive bacteria.

Cefoxitin (Mefoxin)
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Cefoxitin is a second-generation cephalosporin indicated for infections with gram-positive cocci and
gram-negative rods. Infections caused by cephalosporin- or penicillin-resistant gram-negative
bacteria may respond to cefoxitin.

Cefotetan (Cefotan)
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Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible

gram-positive cocci and gram-negative rods. The dose and route of administration depend on the
condition of the patient, the severity of infection, and the susceptibility of the causative organism.

Tetracyclines

Class Summary
Tetracyclines are bacteriostatic broad-spectrum antibiotics derived from cultures of Streptomyces
bacteria; they inhibit protein synthesis in susceptible organisms. These agents work by reversibly
binding to the 30S ribosome of the microbial RNA and preventing the attachment of aminoacyl-
tRNA with the acceptor site on the 70S ribosome.

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Doxycycline (Vibramycin)
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Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly
50S ribosomal subunits of susceptible bacteria.

Antibiotics, Other

Class Summary
Lincosamide antibiotics (eg, clindamycin) inhibit protein synthesis. Imidazole antibiotics (eg,
metronidazole) arrest RNA-dependent protein synthesis.

Clindamycin (Cleocin)
Clindamycin is a lincosamide used for treatment of serious skin and soft tissue staphylococcal
infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It
inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes,
causing RNA-dependent protein synthesis to arrest.

Metronidazole (Flagyl)
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An imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa,
metronidazole is used in combination with other antimicrobial agents (except for treatment of
Clostridium difficile enterocolitis).

Aminoglycosides

Class Summary
Aminoglycosides are a group of injectable bactericidal antibiotics that act by inhibiting bacterial
protein synthesis. All aminoglycosides share the potential for ototoxicity and nephrotoxicity.

Gentamicin (Garamycin)
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Gentamicin is an aminoglycoside antibiotic that provides gram-negative coverage. It is used in

combination with an agent that is effective against gram-positive organisms and one that covers
anaerobes. Dosing regimens are numerous. Adjust dose on the basis of creatinine clearance and
changes in volume of distribution. Measure at least a trough level, drawn on the third or fourth dose
(0.5 hours before dosing); a peak level may be drawn 0.5 hours after a 30-minute infusion.

Penicillins, Amino

Class Summary
An acid-stable semisynthetic penicillin, ampicillin has a broader spectrum of antimicrobial action
than penicillin G does. It inhibits the growth of gram-positive and gram-negative bacteria. It is not
resistant to penicillinase, but when it is combined with the beta-lactamase inhibitor sulbactam, the
spectrum of activity is increased.

Ampicillin-sulbactam (Unasyn)
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This formulation combines ampicillin with a beta-lactamase inhibitor. It interferes with bacterial cell
wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

Uricosuric Agents

Class Summary
Uricosuric agents are used to increase serum concentrations of certain antibiotics and other drugs.

Probenecid
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Probenecid inhibits tubular secretion of penicillin and usually increases penicillin plasma levels,
regardless of the route of penicillin administration. It is used as an adjuvant to therapy with
penicillin, ampicillin, methicillin, oxacillin, cloxacillin, or nafcillin. A 2- to 4-fold elevation of penicillin
plasma levels is demonstrated.

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