Pelvic Inflammatory Diseases
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
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.