QuizMe 21

Pelvic Inflammatory Disease (PID)

A 23-year-old patient, gravida 2, para 2 based on the clinical triad of lower abdominal pain, cervical motion tenderness, and bilateral adnexal tenderness. A history of anaphylaxis that occurred 10 minutes after receiving cefotetan when you treated her for PID when she was 20 years old is documented. In addition to chlamydial infection and gonorrhea testing.

  • Afebrile 
  • No nausea or vomiting 
  • No rebound abdominal tenderness
  • One dose of ceftriaxone intramuscularly (IM) and doxycycline orally twice daily for 14 days 
  • Levofloxacin orally once daily and metronidazole orally twice daily for 14 days
  • One dose of gentamicin IM and one dose of azithromycin orally
  • One dose of spectinomycin IM and one dose of azithromycin orally (E) one dose of cefoxitin IM with probenecid orally and doxycycline orally twice daily for 14 days.

Levofloxacin orally once daily and metronidazole orally twice daily for 14 days

Pelvic inflammatory disease (PID) refers to inflammatory illnesses of the upper female genital tract, which include endometritis, salpingitis, tubal-ovarian abscess, and pelvic peritonitis. Many cases of PID have been linked to sexually transmitted organisms such as Neisseria gonorrhoeae and Chlamydia trachomatis. However,  microorganisms that are part of the vaginal flora  (such as anaerobes,  Gardnerella vaginalis, Haemophilus influenza,  enteric  Gram-negative rods, and  Streptococcus agalactiae)  also have been associated with  PID.

 

Criteria for the Diagnosis of Pelvic Inflammatory Disease:

 

  • lower abdominal pain and tenderness
  • deep dyspareunia
  • abnormal vaginal or cervical discharge
  • cervical excitation and adnexal tenderness motion
  • fever (> 38°C).

 

Admission to the hospital would be appropriate in the following circumstances:

 

  • surgical emergency cannot be excluded
  • clinically severe disease
  • tubo-ovarian abscess
  • PID in pregnancy
  • lack of response to oral therapy
  • intolerance to oral therapy.
  • Ceftriaxone* 500mg single dose followed by oral doxycycline 100mg twice daily plus
  • Metronidazole 400mg twice daily for 14 days.
  • Oral ofloxacin 400mg twice daily plus oral metronidazole 400mg twice daily for 14 days

Alternative Regimens:

  • Intramuscular ceftriaxone 500 mg immediately, followed by azithromycin 1 g/week for 2 weeks
  • Oral moxifloxacin 400mg once daily for 14 days

Notes:

  • Levofloxacin is the L isomer of ofloxacin28 and has the advantage of once-daily dosing (500mg OD for14 days). It may be used as a more convenient alternative to ofloxacin.
  • Metronidazole is included in some regimens to improve coverage for anaerobic bacteria.
Author

Dr Nouf Khailfeh & Dr Aya Al-Shati

Reviewer
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