Pelvic Inflammatory Diseases

Characteristics features

• Lower abdominal pain with uterine, adnexal, or cervical motion tenderness.

Absence of a competing diagnosis.

Management

• Inj Emidoxin (Cefoxitin) 2g IM Stat,

Tab Probenecid 500mg, 2 tab PO stat, and

Cap Doxycycline (Vibramycin) 100mg. 1cap PO BD for 14 days OR

• Inj Ceftriaxone (Oxidil) 250-500mg IM stat plus Cap Doxycylcine (Vibramycin) 100mg 1 cap PO BD for 14days

Tab Metronidazole (Flagyl) 400mg 1 tab PO for 14days

• For patients with severe disease or those who meet the other criteria for hospitalization, the recommended regimen is
• Inj Cefotetan 2g IV BD, OR
• Inj Cefoxitin 2 g, IV QID plus
• Cap Doxycycline (Vibramycin) 100mg PO BD
• Inj Dalacin-C (Clindamycin) 900mg IV TDS plus
• Inj Gentamicin 2mg/kg IV OR IM Stat then 1.5mg/kg TDS

Note

In chronic PID, do not give antibiotics, just give analgesics.

Surgical Measures

• Tubo-ovarian abscesses may require surgical excision or transcutaneous or transvaginal aspiration.
• Unless rupture is suspected, institute high dose antibiotic therapy in the hospital and monitor therapy with ultrasound.
• In 70% of cases. Antibiotics are effective, in 30% cases, there I inadequate response in 48-72hrs, and surgical intervention is required.
• Unilateral adnexectomy is acceptable for unilateral abscess
• Hysterectomy and bilateral salpingo-oophorectomy may be necessary for overwhelming infection or in cases of chronic disease with intractable pelvic pain.