gynecology and obstetrics
Pelvic Inflammatory Disease (PID)
Treatment of PID
Antibiotics to coverN. gonorrhoeae,C. trachomatis, and organisms in the vaginal floras When a PID diagnosis is suspected but cervical infection has not been confirmed or the patient does not meet all clinical criteria, empiric treatment of PID is given for several reasons: Test results may take a few days. Diagnosis based on clinical criteria can be inaccurate. Not treating minimally symptomatic PID can result in serious complications. Antibiotics are given empirically to coverN. gonorrhoeae,C. trachomatis, and vaginal flora, including anaerobes, and are modified based on laboratory test results. Treat empirically for PID whenever the diagnosis is suspected, because test results may take time and be inconclusive, diagnosis based on clinical criteria can be inaccurate, and not treating minimally symptomatic PID can result in serious complications. ) usually also aim to eradicate Treatment , which often coexists. Sex partners of patients withN. gonorrhoeaeorC. trachomatisinfection should be treated. If patients do not improve after treatment that covers the usual pathogens, PID due toM. genitaliumshould be considered. Patients may be treated empirically withmoxifloxacin400 mg orally once a day for 7 to 14 days (eg, for 10 days). Women with PID are usually hospitalized if any of the following are present: Uncertain diagnosis, with inability to exclude a disorder requiring surgical treatment (eg, appendicitis) Pregnancy Severe symptoms or high fever Tubo-ovarian abscess Inability to tolerate or follow outpatient therapy (eg, due to vomiting) Lack of response to outpatient (oral) treatment In these cases, IV antibiotics (see table) are started as soon as cultures are obtained and are continued until patients have been afebrile for 24 hours. may require more prolonged IV antibiotic treatment. Treatment with ultrasound- or CT-guided percutaneous or transvaginal drainage can be considered if response to antibiotics alone is incomplete ( Treatment reference ). Laparoscopy or laparotomy is sometimes required for drainage. Suspicion of a ruptured tubo-ovarian abscess requires immediate laparotomy. In women of reproductive age, surgery should aim to preserve the pelvic organs (with the hope of preserving fertility). 1.Goje O, Markwei M, Kollikonda S, et al: Outcomes of minimally invasive management of tubo-ovarian abscess: A systematic review.J Minim Invasive Gynecol28 (3):556–564, 2021. doi: 10.1016/j.jmig.2020.09.014 