Medication &

MEDICATION
Treatment of pelvic inflammatory disease
(PID),salpingitis
,should
include
empirical broad-spectrum antibiotics to
cover the full complement of common
causes
The Centers for Disease Control and
Prevention (CDC) has outlined antibiotic
regimens for outpatient and inpatient
treatment of PID

INPATIENT

Uncertain diagnosis
Pelvic abscess on ultrasonographic scanning
Pregnancy
Inability to tolerate outpatient oral antibiotic regimen
Severe illness
Immunodeficiency (eg, patients with HIV infection who
have a low CD4 count or patients who are using
immunosuppressive medications)
Failure to improve clinically after 72 hours of
outpatient therapy
Surgical emergencies

PID ORAL REGIMENS

Ceftriaxone 250 mg IM
once, or
Cefoxitin 2 g IM
(probenecid 1 g) plus
Doksisiklin 100 mg
q12h for 14 days
w/wo
Metronidazol 500 mg
PO q12h for 14 days

Ofofloxacin 400 mg
PO q12h,
or
Levofloxacin 500 mg
PO q24h
w/wo
Metronidazole 500 mg
PO q12h for 14 days

PID IV REGIMENS
Regimen parenteral A
Cefotetan 2 g IV q12h or
Cefoxitin 2 g IV q6h, plus
Doxycyline 100 mg PO q12H
* giving in 14 days for doxycycline
* continue for 24 hours after improvement

 Regimen parenteral B
Clindamycin 900 mg IV q8h plus
Gentamicin IV (1,5 mg / kg) q8h, or
7 mg/kg IV q24h
*continue IV for 24 hrs after improvement
*switch to clindamycin 450 mg PO q6h for 14 days

ALTERNATIVE REGIMENS

Ampisilin / sulbaktam
3g IV q6h
plus
Doxycycline 100 mg
PO or IV q12h

Ofloxacin 400 mg IV
q12h, or
Levofloxacin 500 mg
IV q24h,
w/wo
Metronidazole 500
mg IVq8h

CONSULTATIONS
Patients who do not improve in 72 hours
should
be
reevaluated
for
possible
laparoscopic or surgical intervention and for
reconsideration of other possible diagnoses
If patients do not respond appropriately,
laparoscopy may be useful for identifying
loculations of pus requiring drainage

 Unresolved abscesses may be drained

percutaneously via posterior colpotomy,
under computed tomographic (CT) or
ultrasonographic
guidance,
laparoscopically, or through laparotomy
Surgical treatment may involve unilateral
salpingo-oophorectomy or hysterectomy
and bilateral salpingo-oophorectomy

SURGical INTERVENTION

PREVENTION

CDC guidelines recommend that

even if a patient last had sexual
intercourse more than 60 days
before symptom onset or diagnosis,
the most recent sex partner
should be treated

 Patients should be fully educated about

these issues because of low medical
literacy and a poor understanding of their
diagnosis, as well as about the advisability of
testing and treatment for other STIs,
including HIV infection, hepatitis, and syphilis.

 Education should concentrate on

strategies to prevent PID and STIs,
including reducing the number of
sexual partners, avoiding unsafe
sexual practices, and routinely using
appropriate barrier protection

Women with PID should be counseled

to abstain from sexual activity or use
barrier protection strictly and
appropriately until their symptoms and
those of their partner have fully abated
and they have completed their
entire treatment regimen.

 Treatment addresses the relief of

acute symptom , eradication of
current infection, and minimization of
the risk of long-term sequelae,
including chronic pelvic pain, ectopic
pregnancy, tubal factor infertility
(TFI), and implantation failure with in
vitro fertilization attempts

THANK YOU

REFERENCES
Infectious Disease ; A Clinical Short
Course, Second Edition ; Pelvic
Inflammatory Disease
Medscape ; Pelvic Inflammatory
DiseaseTreatment & Management
National Medical Series For Independent
Study ; Pelvic Inflammatory Disease