Materiały źródłowe

• #1 Pelvic inflammatory disease: Treatment in adults and adolescents – UpToDate

  https://www.uptodate.com/contents/pelvic-inflammatory-disease-treatment-in-adults-and-adolescents

  Pelvic inflammatory disease (PID) refers to acute infection of the upper genital tract structures in females, involving any or all of the uterus, fallopian tubes, and ovaries and may involve the neighboring pelvic organs. Early diagnosis and treatment are believed to be key elements in the prevention of long-term sequelae, such as infertility and ectopic pregnancy. […] The treatment of PID will be reviewed here. […] Treatment of PID generally requires broad antimicrobial coverage, particularly among those with severe disease requiring hospitalization. […] The two most important sexually transmitted organisms associated with acute PID, C. trachomatis and N. gonorrhoeae, should be the main targets for treatment. Even if endocervical testing is not positive for either of these pathogens, they should still be covered, as upper tract infection cannot be ruled out. […] Drug resistance is an ongoing challenge in the therapy of gonococcal infections.

• #2 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Treatment of pelvic inflammatory disease (PID) addresses the relief of acute symptoms, eradication of current infection, and minimization of the risk of long-term sequelae. These sequelae, including chronic pelvic pain, ectopic pregnancy, tubal factor infertility (TFI), and implantation failure with in vitro fertilization attempts, may occur in as many as 25% of patients. […] From a public health perspective, treatment is aimed at the expeditious eradication of infection in order to reduce the risk of transmission of infection to new sexual partners. In addition, identification and treatment of current and recent partners are indicated for further reduction of sexually transmitted infections (STIs). […] Early diagnosis and treatment appear to be critical in the preservation of fertility. Current guidelines suggest that empirical treatment should be initiated in at-risk women who have lower abdominal pain, adnexal tenderness, and cervical motion tenderness.

• #3 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Addition of metronidazole to IM or oral PID regimens more effectively eradicates anaerobic organisms from the upper genital tract. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, using regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of recommended antimicrobials. For women with PID of mild or moderate clinical severity, parenteral and oral regimens appear to have similar efficacy. The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded, Tubo-ovarian abscess, Pregnancy, Severe illness, nausea and vomiting, or oral temperature 38.5C (101F), Unable to follow or tolerate an outpatient oral regimen, No clinical response to oral antimicrobial therapy.

• #4 Pelvic Inflammatory Disease (PID) – Harvard Health

  https://www.health.harvard.edu/womens-health/pelvic-inflammatory-disease-pid-a-to-z

  Pelvic inflammatory disease is the most common preventable cause of infertility in the United States. […] The primary treatment for pelvic inflammatory disease is antibiotics, and in most cases, antibiotics alone can cure the infection. […] Because pelvic inflammatory disease often is caused by more than one type of organism, two or more antibiotics may be necessary. […] In most cases, antibiotics must be taken for 10 to 14 days. […] Some women with a severe infection need to be hospitalized to receive antibiotics intravenously. […] If you have an abscess, you may need surgery or a minor procedure to place a drain in the abscess, in addition to antibiotics to cure the infection. […] Getting prompt treatment and follow-up care can cure pelvic inflammatory disease and keep it from causing further problems.

• #5 Pelvic Inflammatory Disease (PID): Symptoms, Causes, & Treatment

  https://www.webmd.com/women/what-is-pelvic-inflammatory-disease

  If you have PID, your doctor will most likely prescribe antibiotics to kill the bacteria that caused the infection. […] Many types of antibiotics treat PID, including ceftriaxone, doxycycline, and metronidazole. You may take more than one type of antibiotic at the same time to help the medicine work better. […] Antibiotics can clear up a PID infection, but they cant get rid of scars that the infection may have left in your pelvis. […] Your sex partner should also take antibiotics so they dont infect you again. […] The doctor may follow up with you in 3 days to see if your symptoms have improved. If your symptoms dont improve, you may need a different type of antibiotic. Complete the entire course of medication even if you feel better. […] You may need treatment in a hospital if you: […] The hospital staff may give you stronger antibiotics through your vein or by mouth. […] A few antibiotics work against PID. You may get a combination of two or three medicines such as ceftriaxone, doxycycline, and metronidazole.

• #6 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Addition of metronidazole to IM or oral PID regimens more effectively eradicates anaerobic organisms from the upper genital tract. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, using regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of recommended antimicrobials. For women with PID of mild or moderate clinical severity, parenteral and oral regimens appear to have similar efficacy. The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded, Tubo-ovarian abscess, Pregnancy, Severe illness, nausea and vomiting, or oral temperature 38.5C (101F), Unable to follow or tolerate an outpatient oral regimen, No clinical response to oral antimicrobial therapy.

• #7 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  PID treatment regimens should provide empiric, broad-spectrum coverage of likely pathogens. Multiple parenteral and oral antimicrobial regimens have been effective in achieving clinical and microbiologic cure in randomized clinical trials with short-term follow-up. However, only a limited number of studies have assessed and compared these regimens with regard to infection elimination in the endometrium and fallopian tubes or determined the incidence of long-term complications (e.g., tubal infertility and ectopic pregnancy) after antimicrobial regimens. The optimal treatment regimen and long-term outcome of early treatment of women with subclinical PID are unknown. All regimens used to treat PID should also be effective against N. gonorrhoeae and C. trachomatis because negative endocervical screening for these organisms does not rule out upper genital tract infection. Anaerobic bacteria have been isolated from the upper genital tract of women who have PID, and data from in vitro studies have revealed that some anaerobes (e.g., Bacteroides fragilis) can cause tubal and epithelial destruction.

• #8 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #9 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  In the emergency department, clinic, or office setting, treatment should be expeditiously initiated and should include empirical broad-spectrum antibiotics to cover the full complement of common organisms. […] The recommended intramuscular or oral regimens for PID are as follows: Ceftriaxone at 500 mg IM in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days WITH metronidazole at 500 mg PO BID for 14 days. […] After the patient shows clinical improvement with parenteral therapy, transition to oral therapy with doxycycline 100 mg 2 times/day and metronidazole 500 mg 2 times/day is recommended to complete a total of 14 days of antimicrobial therapy.

• #10 Table: Regimens for Treatment of Pelvic Inflammatory Disease*-Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/multimedia/table/regimens-for-treatment-of-pelvic-inflammatory-disease

  Regimens for Treatment of Pelvic Inflammatory Disease […] Parenteral […] Regimen A: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours […] Regimen B: Cefotetan 2 g IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours […] Regimen C: Ampicillin/sulbactam 3 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours […] Regimen D: Clindamycin 900 mg IV every 8 hours PLUS Gentamicin 2 mg/kg IV or IM (loading dose), followed by 1.5 mg/kg every 8 hours (maintenance dose); can be substituted with single daily dosing (35 mg/kg once a day) […] Oral or IM […] Regimen A: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH Metronidazole 500 mg orally twice a day for 14 days

• #11 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  The recommended intramuscular or oral regimens for pelvic inflammatory disease are as follows: Ceftriaxone at 500 mg IM in a single dose (for persons weighing 150 kg, administer 1 g of ceftriaxone) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Cefoxitin at 2 g IM in a single dose and probenecid at 1 g PO administered concurrently in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Other parenteral third-generation cephalosporin (eg, ceftizoxime, cefotaxime) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days. […] The PID recurrence rate is 15%-21%, of which 20%-34% cases are due to recurrent STI. Follow-up is recommended. Personalized text message reminders improve the likelihood of follow-up compliance. NAAT of vaginal samples to evaluate for N gonorrhoeae, C trachomatis, and M genitalium should be performed 3-6 months after treatment of STI-associated PID to rule out reinfection. Condom use after STI-associated PID reduces the recurrence risk. […] Prior to insertion of an intrauterine device, vaginal sampling for microbiological diagnosis is recommended. Women with PID are at high risk of ectopic pregnancy.

• #12 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #13 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  The recommended intramuscular or oral regimens for pelvic inflammatory disease are as follows: Ceftriaxone at 500 mg IM in a single dose (for persons weighing 150 kg, administer 1 g of ceftriaxone) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Cefoxitin at 2 g IM in a single dose and probenecid at 1 g PO administered concurrently in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Other parenteral third-generation cephalosporin (eg, ceftizoxime, cefotaxime) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days. […] The PID recurrence rate is 15%-21%, of which 20%-34% cases are due to recurrent STI. Follow-up is recommended. Personalized text message reminders improve the likelihood of follow-up compliance. NAAT of vaginal samples to evaluate for N gonorrhoeae, C trachomatis, and M genitalium should be performed 3-6 months after treatment of STI-associated PID to rule out reinfection. Condom use after STI-associated PID reduces the recurrence risk. […] Prior to insertion of an intrauterine device, vaginal sampling for microbiological diagnosis is recommended. Women with PID are at high risk of ectopic pregnancy.

• #14 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #15

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/

  If it’s diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. […] Treatment with antibiotics needs to be started quickly, before the results of the swabs are available. […] You’ll usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection. […] It’s very important to complete the entire course of antibiotics, even if you’re feeling better, to help ensure the infection is properly cleared. […] In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously). […] In some cases, you may be advised to have a follow-up appointment 3 days after starting treatment so your doctor can check if the antibiotics are working.

• #16 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #17 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #18 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #19 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #20 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #21 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #22 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #23 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #24 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #25 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #26 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  In 2021, the Centers for Disease Control and Prevention (CDC) updated its clinical practice guidelines on the treatment of sexually transmitted infections. These are some of the highlights of the recommendations for the treatment of pelvic inflammatory disease. […] The recommended parenteral treatment regimens for pelvic inflammatory disease are as follows: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours PLUS Metronidazole at 500 mg PO or IV every 12 hours OR Cefotetan at 2 g IV every 12 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Cefoxitin at 2 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours. […] Alternative parenteral treatment regimens are as follows: Ampicillin-sulbactam at 3 g IV every 6 hours PLUS Doxycycline at 100 mg PO or IV every 12 hours OR Clindamycin at 900 mg IV every 8 hours PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight), followed by a maintenance dose (1.5 mg/kg body weight) every 8 hours; can substitute single daily dosing (3-5 mg/kg body weight).

• #27 Pelvic Inflammatory Disease – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK499959/

  Pelvic inflammatory disease (PID) is treated with antibiotics to cover the primary pathogens, including Neisseria gonorrhoeae and Chlamydia trachomatis. […] Early and prompt treatment should be started based on clinical suspicion. […] Empiric treatment for PID in the inpatient setting includes: Cefotetan (2 g intravenously [IV] every 12 hours) plus doxycycline (100 mg by mouth every 12 hours) or Cefoxitin (2 g IV every 6 hours) plus doxycycline (100 mg by mouth every 12 hours) or Clindamycin (900 mg IV every 8 hours) plus gentamicin (3 to 5 mg/kg IV once daily). […] The CDC recommends the following for first-line treatment for outpatient therapy: Doxycycline (100 mg orally twice a day for 2 weeks) plus ceftriaxone 500 mg intramuscularly (IM) for one dose or cefoxitin 2 g IM with probenecid (1g orally) for one dose or another parenteral third-generation cephalosporin. […] Metronidazole (500 mg orally twice per day for 14 days) should be added if there is a concern for trichomonas or recent vaginal instrumentation.

• #28 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Randomized trials have demonstrated the efficacy of parenteral regimens. Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24-48 hours of clinical improvement. For women with tubo-ovarian abscesses, 24 hours of inpatient observation is recommended. Recommended Parenteral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours OR Cefotetan 2 g IV every 12 hours PLUS Doxycycline 100 mg orally or IV every 12 hours OR Cefoxitin 2 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours. […] IM or oral therapy can be considered for women with mild-to-moderate acute PID because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM or oral therapy within 72 hours should be reevaluated to confirm the diagnosis and be administered therapy IV. Recommended Intramuscular or Oral Regimens for Pelvic Inflammatory Disease: Ceftriaxone 500 mg IM in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days OR Cefoxitin 2 g IM in a single dose and Probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally 2 times/day for 14 days WITH Metronidazole 500 mg orally 2 times/day for 14 days.

• #29 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  In the emergency department, clinic, or office setting, treatment should be expeditiously initiated and should include empirical broad-spectrum antibiotics to cover the full complement of common organisms. […] The recommended intramuscular or oral regimens for PID are as follows: Ceftriaxone at 500 mg IM in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days WITH metronidazole at 500 mg PO BID for 14 days. […] After the patient shows clinical improvement with parenteral therapy, transition to oral therapy with doxycycline 100 mg 2 times/day and metronidazole 500 mg 2 times/day is recommended to complete a total of 14 days of antimicrobial therapy.

• #30 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  In the emergency department, clinic, or office setting, treatment should be expeditiously initiated and should include empirical broad-spectrum antibiotics to cover the full complement of common organisms. […] The recommended intramuscular or oral regimens for PID are as follows: Ceftriaxone at 500 mg IM in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days WITH metronidazole at 500 mg PO BID for 14 days. […] After the patient shows clinical improvement with parenteral therapy, transition to oral therapy with doxycycline 100 mg 2 times/day and metronidazole 500 mg 2 times/day is recommended to complete a total of 14 days of antimicrobial therapy.

• #31 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Addition of metronidazole to IM or oral PID regimens more effectively eradicates anaerobic organisms from the upper genital tract. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, using regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of recommended antimicrobials. For women with PID of mild or moderate clinical severity, parenteral and oral regimens appear to have similar efficacy. The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded, Tubo-ovarian abscess, Pregnancy, Severe illness, nausea and vomiting, or oral temperature 38.5C (101F), Unable to follow or tolerate an outpatient oral regimen, No clinical response to oral antimicrobial therapy.

• #32 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Most tubo-ovarian abscesses (TOAs) (60-80%) resolve with antibiotic administration. If patients do not respond appropriately, laparoscopy may be useful for identifying loculations of pus requiring drainage. […] The advantages of laparoscopy include direct visualization of the pelvis and more accurate bacteriologic diagnosis if cultures are obtained. […] Surgical treatment may involve unilateral salpingo-oophorectomy or hysterectomy and bilateral salpingo-oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. […] Most patients with PID are managed as outpatients, and the available data do not clearly indicate that patients benefit from hospitalization. However, hospitalization should be considered for patients with the following conditions: Uncertain diagnosis, Pelvic abscess on ultrasonographic scanning, Pregnancy, Inability to tolerate outpatient oral antibiotic regimen, Severe illness, Immunodeficiency, Failure to improve clinically after 72 hours of outpatient therapy.

• #33 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Addition of metronidazole to IM or oral PID regimens more effectively eradicates anaerobic organisms from the upper genital tract. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, using regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of recommended antimicrobials. For women with PID of mild or moderate clinical severity, parenteral and oral regimens appear to have similar efficacy. The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded, Tubo-ovarian abscess, Pregnancy, Severe illness, nausea and vomiting, or oral temperature 38.5C (101F), Unable to follow or tolerate an outpatient oral regimen, No clinical response to oral antimicrobial therapy.

• #34 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Most tubo-ovarian abscesses (TOAs) (60-80%) resolve with antibiotic administration. If patients do not respond appropriately, laparoscopy may be useful for identifying loculations of pus requiring drainage. […] The advantages of laparoscopy include direct visualization of the pelvis and more accurate bacteriologic diagnosis if cultures are obtained. […] Surgical treatment may involve unilateral salpingo-oophorectomy or hysterectomy and bilateral salpingo-oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. […] Most patients with PID are managed as outpatients, and the available data do not clearly indicate that patients benefit from hospitalization. However, hospitalization should be considered for patients with the following conditions: Uncertain diagnosis, Pelvic abscess on ultrasonographic scanning, Pregnancy, Inability to tolerate outpatient oral antibiotic regimen, Severe illness, Immunodeficiency, Failure to improve clinically after 72 hours of outpatient therapy.

• #35 Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html

  Treatment does not change in patients with intrauterine devices or those with HIV. […] The current Centers for Disease Control and Prevention (CDC) recommendations for inpatient and outpatient treatment of PID are listed in Table 3 and Table 4. Antibiotic selection is based on the need for inpatient vs. outpatient care. No differences in pregnancy rates, time to pregnancy, PID recurrence, chronic pelvic pain, or ectopic pregnancy have been found in women with mild to moderate PID who receive outpatient treatment. […] Indications for inpatient treatment include pregnancy; failure or intolerance of oral therapy; high fever, nausea, vomiting, intractable abdominal pain, or severe illness; tubo-ovarian abscess; or when surgical emergency cannot be excluded. […] Patients may be transitioned from parenteral to oral therapy after 24 hours of clinical improvement. Completion of 14 days of treatment with oral medications is recommended.

• #36 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  Addition of metronidazole to IM or oral PID regimens more effectively eradicates anaerobic organisms from the upper genital tract. Until treatment regimens that do not cover anaerobic microbes have been demonstrated to prevent long-term sequelae (e.g., infertility and ectopic pregnancy) as successfully as the regimens that are effective against these microbes, using regimens with anaerobic activity should be considered. Treatment should be initiated as soon as the presumptive diagnosis has been made because prevention of long-term sequelae is dependent on early administration of recommended antimicrobials. For women with PID of mild or moderate clinical severity, parenteral and oral regimens appear to have similar efficacy. The decision of whether hospitalization is necessary should be based on provider judgment and whether the woman meets any of the following criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded, Tubo-ovarian abscess, Pregnancy, Severe illness, nausea and vomiting, or oral temperature 38.5C (101F), Unable to follow or tolerate an outpatient oral regimen, No clinical response to oral antimicrobial therapy.

• #37 Pelvic Inflammatory Disease: Diagnosis, Management, and Prevention | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0915/p357.html

  The importance of extended anaerobic coverage in the treatment of PID is still unknown. The CDC currently recommends considering the addition of metronidazole in all outpatient treatment of PID and in patients who have trichomoniasis, BV, or recent uterine instrumentation. […] Because of emerging resistance, routine quinolone use is no longer recommended as PID treatment in providing empiric coverage for gonorrhea. […] If the culture isolate is found to be quinolone-resistant and the patient has a cephalosporin allergy, consultation with an infectious disease subspecialist is recommended, or inpatient treatment with clindamycin or gentamicin can be used.

• #38 Pelvic Inflammatory Disease (PID) – STI Treatment Guidelines

  https://www.cdc.gov/std/treatment-guidelines/pid.htm

  These regimens provide coverage against frequent etiologic agents of PID; however, the optimal choice of a cephalosporin is unclear. Cefoxitin, a second-generation cephalosporin, has better anaerobic coverage than ceftriaxone, and, in combination with probenecid and doxycycline, has been effective in short-term clinical response among women with PID. Ceftriaxone has better coverage against N. gonorrhoeae. The addition of metronidazole to these regimens provides extended coverage against anaerobic organisms and will also effectively treat BV, which is frequently associated with PID.

• #39 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Therapy with antibiotics alone is successful in 33-75% of cases. If surgical treatment is warranted, the current trend is toward conservation of reproductive potential with simple drainage, adhesiolysis, and copious irrigation or unilateral adnexectomy, if possible. […] Based on studies done with the copper IUD, the CDC advises that there is insufficient evidence to recommend removal of intrauterine devices (IUDs) in women diagnosed with acute PID. However, antibiotics and close clinical follow-up is mandatory if the IUD is left in place. […] Current evidence suggests that adherence to clinical guidelines for PID diagnosis and management is less than optimal. […] Patients who do not improve in 72 hours should be reevaluated for possible laparoscopic or surgical intervention and for reconsideration of other possible diagnoses.

• #40 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Therapy with antibiotics alone is successful in 33-75% of cases. If surgical treatment is warranted, the current trend is toward conservation of reproductive potential with simple drainage, adhesiolysis, and copious irrigation or unilateral adnexectomy, if possible. […] Based on studies done with the copper IUD, the CDC advises that there is insufficient evidence to recommend removal of intrauterine devices (IUDs) in women diagnosed with acute PID. However, antibiotics and close clinical follow-up is mandatory if the IUD is left in place. […] Current evidence suggests that adherence to clinical guidelines for PID diagnosis and management is less than optimal. […] Patients who do not improve in 72 hours should be reevaluated for possible laparoscopic or surgical intervention and for reconsideration of other possible diagnoses.

• #41 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Most tubo-ovarian abscesses (TOAs) (60-80%) resolve with antibiotic administration. If patients do not respond appropriately, laparoscopy may be useful for identifying loculations of pus requiring drainage. […] The advantages of laparoscopy include direct visualization of the pelvis and more accurate bacteriologic diagnosis if cultures are obtained. […] Surgical treatment may involve unilateral salpingo-oophorectomy or hysterectomy and bilateral salpingo-oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. […] Most patients with PID are managed as outpatients, and the available data do not clearly indicate that patients benefit from hospitalization. However, hospitalization should be considered for patients with the following conditions: Uncertain diagnosis, Pelvic abscess on ultrasonographic scanning, Pregnancy, Inability to tolerate outpatient oral antibiotic regimen, Severe illness, Immunodeficiency, Failure to improve clinically after 72 hours of outpatient therapy.

• #42 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Most tubo-ovarian abscesses (TOAs) (60-80%) resolve with antibiotic administration. If patients do not respond appropriately, laparoscopy may be useful for identifying loculations of pus requiring drainage. […] The advantages of laparoscopy include direct visualization of the pelvis and more accurate bacteriologic diagnosis if cultures are obtained. […] Surgical treatment may involve unilateral salpingo-oophorectomy or hysterectomy and bilateral salpingo-oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. […] Most patients with PID are managed as outpatients, and the available data do not clearly indicate that patients benefit from hospitalization. However, hospitalization should be considered for patients with the following conditions: Uncertain diagnosis, Pelvic abscess on ultrasonographic scanning, Pregnancy, Inability to tolerate outpatient oral antibiotic regimen, Severe illness, Immunodeficiency, Failure to improve clinically after 72 hours of outpatient therapy.

• #43 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Most tubo-ovarian abscesses (TOAs) (60-80%) resolve with antibiotic administration. If patients do not respond appropriately, laparoscopy may be useful for identifying loculations of pus requiring drainage. […] The advantages of laparoscopy include direct visualization of the pelvis and more accurate bacteriologic diagnosis if cultures are obtained. […] Surgical treatment may involve unilateral salpingo-oophorectomy or hysterectomy and bilateral salpingo-oophorectomy. Ideally, the operation is performed after the acute infection and inflammation have resolved. […] Most patients with PID are managed as outpatients, and the available data do not clearly indicate that patients benefit from hospitalization. However, hospitalization should be considered for patients with the following conditions: Uncertain diagnosis, Pelvic abscess on ultrasonographic scanning, Pregnancy, Inability to tolerate outpatient oral antibiotic regimen, Severe illness, Immunodeficiency, Failure to improve clinically after 72 hours of outpatient therapy.

• #44 Pelvic inflammatory disease: Symptoms, treatment, causes, and more

  https://www.medicalnewstoday.com/articles/177923

  This is rarely needed, but it may be needed if there is scarring on the fallopian tubes or if an abscess needs draining. […] The womans sexual partner may need to seek treatment for an STI. If the partner has an STI, there is a serious risk of recurrence if it goes untreated. […] The patient should refrain from sex until the treatment is completed.

• #45 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Therapy with antibiotics alone is successful in 33-75% of cases. If surgical treatment is warranted, the current trend is toward conservation of reproductive potential with simple drainage, adhesiolysis, and copious irrigation or unilateral adnexectomy, if possible. […] Based on studies done with the copper IUD, the CDC advises that there is insufficient evidence to recommend removal of intrauterine devices (IUDs) in women diagnosed with acute PID. However, antibiotics and close clinical follow-up is mandatory if the IUD is left in place. […] Current evidence suggests that adherence to clinical guidelines for PID diagnosis and management is less than optimal. […] Patients who do not improve in 72 hours should be reevaluated for possible laparoscopic or surgical intervention and for reconsideration of other possible diagnoses.

• #46 Pelvic inflammatory diseases (PID) | STI Guidelines Australia

  https://sti.guidelines.org.au/syndromes/pelvic-inflammatory-diseases-pid/

  Prompt treatment is essential to prevent long-term sequelae (including tubal infertility, ectopic pregnancy and chronic pelvic pain). […] Rapid response to appropriate antibiotic treatment is highly predictive of PID. […] Begin treatment immediately with provisional diagnosis, without waiting for test results. […] For patients who may be breast feeding or non-adherent to doxycycline, consider replacing with Azithromycin 1g PO stat plus a further dose 1 week later. […] Consider removal of IUD if no response to treatment within 48-72 hours. […] Diagnosis is clinical and a low threshold of suspicion is necessary due to wide clinical spectrum (asymptomatic to severe). […] Treatment advice includes beginning treatment immediately with provisional diagnosis, without waiting for test results. […] If pregnant or breastfeeding, avoid doxycycline and use azithromycin regimen.

• #47 Pelvic inflammatory disease treatment guidelines – Melbourne Sexual Health Centre (MSHC)

  https://www.mshc.org.au/health-professionals/treatment-guidelines/pelvic-inflammatory-disease-treatment-guidelines

  Women should ideally be reviewed at 72 hours. If there is no clinical improvement, consider an alternative diagnosis and/or referral for further investigation and inpatient treatment. […] If an STI is isolated, refer to specific treatment guideline for retesting and contact tracing. […] Severe PID: Refer to hospital for intravenous antibiotics. […] Pregnant woman with PID: As there is a high risk of maternal morbidity and premature delivery associated with PID in pregnancy, consider inpatient admission for intravenous antibiotics. […] Woman with intrauterine contraceptive device (IUCD): Consider removing the IUCD in women with mild to moderate PID if there is no clinical improvement at 72 hours. […] Women with severe PID with an IUCD in situ should be referred to hospital. […] Current sexual partners should be tested for STIs and offered treatment at the first visit with doxycycline 100mg PO, twice daily for 7 days.

• #48 Pelvic inflammatory diseases (PID) | STI Guidelines Australia

  https://sti.guidelines.org.au/syndromes/pelvic-inflammatory-diseases-pid/

  Prompt treatment is essential to prevent long-term sequelae (including tubal infertility, ectopic pregnancy and chronic pelvic pain). […] Rapid response to appropriate antibiotic treatment is highly predictive of PID. […] Begin treatment immediately with provisional diagnosis, without waiting for test results. […] For patients who may be breast feeding or non-adherent to doxycycline, consider replacing with Azithromycin 1g PO stat plus a further dose 1 week later. […] Consider removal of IUD if no response to treatment within 48-72 hours. […] Diagnosis is clinical and a low threshold of suspicion is necessary due to wide clinical spectrum (asymptomatic to severe). […] Treatment advice includes beginning treatment immediately with provisional diagnosis, without waiting for test results. […] If pregnant or breastfeeding, avoid doxycycline and use azithromycin regimen.

• #49 Pelvic Inflammatory Disease (PID) (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/std-pid.html

  Pelvic inflammatory disease (PID) is an infection of the ovaries, fallopian tubes, and/or uterus. It is usually caused by an STD (sexually transmitted disease). Treatment with antibiotics can help prevent long-lasting problems. […] Health care providers treat PID with antibiotics. All sexual partners from the past 2 months also need treatment. Sometimes the health care provider can prescribe antibiotics for someones partner(s) too. […] Girls who are getting treated for PID should not have sex until: treatment is finished and there are no more signs of PID; partners have been treated and have no symptoms.

• #50

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/

  If your symptoms haven’t started to improve within 3 days, you may be advised to attend hospital for further tests and treatment. […] Any sexual partners you have been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified. […] It’s more likely to return if both partners aren’t treated at the same time.

• #51 Pelvic Inflammatory Disease: Risk Factors, Symptoms & Treatments

  https://www.healthline.com/health/pelvic-inflammatory-disease-pid

  The bacteria that cause PID can spread through sexual contact. If you’re sexually active, your partner should also get treated for PID. Men may be silent carriers of bacteria that cause pelvic inflammatory disease. […] Your infection can recur if your partner doesn’t receive treatment. You may be asked to abstain from sexual intercourse until the infection has been resolved.

• #52 Pelvic Inflammatory Disease Guidelines: Guidelines Summary, SPILF/CNGOF Pelvic Inflammatory Disease Guidelines

  https://emedicine.medscape.com/article/256448-guidelines

  The recommended intramuscular or oral regimens for pelvic inflammatory disease are as follows: Ceftriaxone at 500 mg IM in a single dose (for persons weighing 150 kg, administer 1 g of ceftriaxone) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Cefoxitin at 2 g IM in a single dose and probenecid at 1 g PO administered concurrently in a single dose PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days OR Other parenteral third-generation cephalosporin (eg, ceftizoxime, cefotaxime) PLUS Doxycycline at 100 mg PO BID for 14 days with metronidazole at 500 mg PO BID for 14 days. […] The PID recurrence rate is 15%-21%, of which 20%-34% cases are due to recurrent STI. Follow-up is recommended. Personalized text message reminders improve the likelihood of follow-up compliance. NAAT of vaginal samples to evaluate for N gonorrhoeae, C trachomatis, and M genitalium should be performed 3-6 months after treatment of STI-associated PID to rule out reinfection. Condom use after STI-associated PID reduces the recurrence risk. […] Prior to insertion of an intrauterine device, vaginal sampling for microbiological diagnosis is recommended. Women with PID are at high risk of ectopic pregnancy.

• #53

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/

  If it’s diagnosed at an early stage, pelvic inflammatory disease (PID) can be treated easily and effectively with antibiotics. […] Treatment with antibiotics needs to be started quickly, before the results of the swabs are available. […] You’ll usually have to take the antibiotic tablets for 14 days, sometimes beginning with a single antibiotic injection. […] It’s very important to complete the entire course of antibiotics, even if you’re feeling better, to help ensure the infection is properly cleared. […] In particularly severe cases of PID, you may have to be admitted to hospital to receive antibiotics through a drip in your arm (intravenously). […] In some cases, you may be advised to have a follow-up appointment 3 days after starting treatment so your doctor can check if the antibiotics are working.

• #54

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/

  If your symptoms haven’t started to improve within 3 days, you may be advised to attend hospital for further tests and treatment. […] Any sexual partners you have been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified. […] It’s more likely to return if both partners aren’t treated at the same time.

• #55

  https://www.nhs.uk/conditions/pelvic-inflammatory-disease-pid/treatment/

  If your symptoms haven’t started to improve within 3 days, you may be advised to attend hospital for further tests and treatment. […] Any sexual partners you have been with in the 6 months before your symptoms started should be tested and treated to stop the infection recurring or being spread to others, even if no specific cause is identified. […] It’s more likely to return if both partners aren’t treated at the same time.

• #56 Pelvic inflammatory disease

  http://www.idph.state.il.us/public/hb/hbpid.htm

  Women being treated for PID should be re-evaluated by their health care provider three days after starting treatment to be sure the antibiotics are working to cure the infection. […] Hospitalization to treat PID may be recommended if the woman (1) is severely ill (e.g., nausea, vomiting, and high fever); (2) is pregnant; (3) does not respond to or cannot take oral medication and needs intravenous antibiotics; (4) has an abscess in the fallopian tube or ovary (tubo-ovarian abscess); or (5) needs to be monitored to be sure that her symptoms are not due to another condition that would require emergency surgery (e.g., appendicitis). […] If symptoms continue or if an abscess does not go away, surgery may be needed. […] Follow-up: Take all medications as directed. […] Set up a follow-up exam 48 to 72 hours after start of treatment to make sure the medicine is working. […] Return for another exam after completion of treatment to make sure the infection is completely gone. […] Tell your partner to get tested and treated. […] Do not have sex until you and your partner(s) have been treated and cured.

• #57 Pelvic Inflammatory Disease (PID) (for Teens) | Nemours KidsHealth

  https://kidshealth.org/en/teens/std-pid.html

  Pelvic inflammatory disease (PID) is an infection of the ovaries, fallopian tubes, and/or uterus. It is usually caused by an STD (sexually transmitted disease). Treatment with antibiotics can help prevent long-lasting problems. […] Health care providers treat PID with antibiotics. All sexual partners from the past 2 months also need treatment. Sometimes the health care provider can prescribe antibiotics for someones partner(s) too. […] Girls who are getting treated for PID should not have sex until: treatment is finished and there are no more signs of PID; partners have been treated and have no symptoms.

• #58 Pelvic Inflammatory Disease (PID): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/9129-pelvic-inflammatory-disease-pid

  Pelvic inflammatory disease (PID) is an infection that occurs in your uterus, fallopian tubes or ovaries. […] Prompt PID treatment, usually antibiotics, helps avoid complications such as infertility. […] Your provider will prescribe antibiotics that you take by mouth, typically for 14 days. Make sure to take all your medicine, even if you start feeling better. […] Some people take antibiotics and still have symptoms. If that happens, you may need to go to the hospital to receive antibiotics through an IV. […] Surgery is rare for PID but can help in some cases. If you still have symptoms or an abscess after taking antibiotics, talk to your healthcare provider about surgery. […] If you have pelvic inflammatory disease, tell your sexual partner(s). They should receive treatment. Otherwise, you may get PID again when you resume sex. […] If you get prompt diagnosis and treatment for an infection, antibiotics can cure PID. But treatment cant reverse any damage that already happened to your reproductive organs. […] The most important thing you can do is get treatment.

• #59 Pelvic Inflammatory Disease Treatment & Management: Approach Considerations, Consultations, Prevention

  https://emedicine.medscape.com/article/256448-treatment

  Treatment of pelvic inflammatory disease (PID) addresses the relief of acute symptoms, eradication of current infection, and minimization of the risk of long-term sequelae. These sequelae, including chronic pelvic pain, ectopic pregnancy, tubal factor infertility (TFI), and implantation failure with in vitro fertilization attempts, may occur in as many as 25% of patients. […] From a public health perspective, treatment is aimed at the expeditious eradication of infection in order to reduce the risk of transmission of infection to new sexual partners. In addition, identification and treatment of current and recent partners are indicated for further reduction of sexually transmitted infections (STIs). […] Early diagnosis and treatment appear to be critical in the preservation of fertility. Current guidelines suggest that empirical treatment should be initiated in at-risk women who have lower abdominal pain, adnexal tenderness, and cervical motion tenderness.

• #60 Pelvic Inflammatory Disease (PID)

  https://dph.illinois.gov/topics-services/diseases-and-conditions/diseases-a-z-list/pelvic-inflammatory-disease.html

  Treatment may include antibiotics used to treat gonorrhea, chlamydia, streptococci and other gram-negative bacteria. […] Aggressive treatment of PID is recommended for women with HIV who may be more likely to require surgical intervention. […] PID can be cured with several types of antibiotics. A health care provider will determine and prescribe the best therapy. However, antibiotic treatment does not reverse any damage that has already occurred to the reproductive organs. If a woman has pelvic pain and other symptoms of PID, it is critical that she seek care immediately. Prompt antibiotic treatment can prevent severe damage to reproductive organs. The longer a woman delays treatment for PID, the more likely she is to become infertile or to have a future ectopic pregnancy because of damage to the fallopian tubes.

• #61 About Pelvic Inflammatory Disease (PID) | Pelvic Inflammatory Disease (PID) | CDC

  https://www.cdc.gov/pid/about/index.html

  Yes, if PID is diagnosed early, it can be treated. However, treatment won’t undo any damage that has already happened to your reproductive system. The longer you wait to get treated, the more likely it is that you will have complications from PID. […] If diagnosed and treated early, the complications of PID can be prevented. Some of the complications of PID are formation of scar tissue both outside and inside the fallopian tubes that can lead to tubal blockage, ectopic pregnancy (pregnancy outside the womb), infertility (inability to get pregnant), and long-term pelvic/abdominal pain.

• #62 Management of Pelvic Inflammatory Disease in Clinical Practice

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9939802/

  Addressing non-adherence to guidelines is vital to reducing the morbidity associated with low-quality PID care to meet the United States Healthy People 2030 goals to reduce PID in young women and to promote the health and well-being of women. […] Treatment guidelines for PID widely recommend broad-spectrum antibiotics to cover the commonly implicated organisms (e,g, C. trachomatis, N. gonorrhoeae, and anaerobes). […] Rising antibiotic resistance has become a driving factor in identifying alternative approaches to PID treatment, and novel treatment strategies that utilize non-pharmacological therapies are being considered. […] Effective, broad-spectrum antimicrobial agents are the mainstay of PID treatment and the prevention of associated sequelae such as tubal factor infertility.

• #63 Core Concepts – Pelvic Inflammatory Disease – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/pelvic-inflammatory-disease/core-concept/all

  Pelvic inflammatory disease (PID) is a clinical syndrome characterized by infection and inflammation of the upper female genital tract. […] Effective parenteral and oral treatments are available for PID that provide short-term clinical benefit and reduce the risk of developing long-term complications. […] When considering the severe potential long-term consequences associated with PID, it is extremely important for clinicians to diagnose PID and promptly provide appropriate and effective antimicrobial therapy. […] Treatment should not be withheld while waiting for STI testing results. Timely administration of antimicrobial therapy improves outcomes and reduces the risk of long-term adverse sequelae. […] The empiric treatment regimens should provide broad-spectrum coverage of the likely causative pathogens, most notably N. gonorrhoeae, C. trachomatis, and anaerobic organisms.

• #64 Core Concepts – Pelvic Inflammatory Disease – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/pelvic-inflammatory-disease/core-concept/all

  Multiple parenteral, oral, and parenteral-oral combination antimicrobial regimens have been effective in achieving clinical and microbiologic cure in clinical trials. […] There are sufficient data to support treatment of PID with oral regimens, parenteral antimicrobials, or a combination of both, depending on the severity of the clinical illness. […] The decision of whether to hospitalize for more intense monitoring and treatment can be challenging. […] Multiple randomized trials have demonstrated the efficacy of parenteral regimens for the treatment of acute PID. […] For initial parenteral therapy for PID, there are three recommended and two alternative regimens. […] Clinical experience should guide decisions regarding transition to oral therapy, which usually can be initiated within 24 to 48 hours of clinical improvement.

• #65 Core Concepts – Pelvic Inflammatory Disease – Self-Study Lessons – National STD Curriculum

  https://www.std.uw.edu/go/comprehensive-study/pelvic-inflammatory-disease/core-concept/all

  For women with mild-to-moderate acute PID, intramuscular (IM) or oral therapy can be considered because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. […] Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy. […] For women diagnosed with PID who have a cephalosporin allergy, limited data suggest the Alternative Therapy options could be used, if the PID occurs in a setting of low risk for gonorrhea. […] Women with suspected or diagnosed tubo-ovarian abscess should undergo hospitalization for intensive management, including prompt receipt of intravenous antimicrobial therapy and expert consultation. […] Women with PID who receive adequate antimicrobial therapy will typically show significant clinical improvement within 72 hours after initiation of therapy. […] All recent sex partners of women with PID should receive evaluation and empiric treatment for chlamydia and gonorrhea, regardless of the pathogens identified in the woman with PID.

• #66 Pelvic Inflammatory Disease: Strategies for Treatment and Prevention

  https://www.uspharmacist.com/article/pelvic-inflammatory-disease-strategies-for-treatment-and-prevention

  When patients do become infected with PID during hormonal contraceptive use, PID appears to have less severe inflammation. […] As with any antimicrobial therapy, it is worth noting that perturbing the normal vaginal flora may result in a yeast infection, especially in those patients who are prone to such infections. […] Screening for chlamydia and gonorrhea in all sexually active females younger than 25 years and in older women with high-risk behaviors is an important strategy in identifying patients with or at risk for PID and initiating early treatment. […] While antimicrobial therapy is highly effective, the focus of practitioners efforts should be to prevent long-term reproductive sequelae associated with PID.

• #67 Pelvic Inflammatory Disease: Strategies for Treatment and Prevention

  https://www.uspharmacist.com/article/pelvic-inflammatory-disease-strategies-for-treatment-and-prevention

  When patients do become infected with PID during hormonal contraceptive use, PID appears to have less severe inflammation. […] As with any antimicrobial therapy, it is worth noting that perturbing the normal vaginal flora may result in a yeast infection, especially in those patients who are prone to such infections. […] Screening for chlamydia and gonorrhea in all sexually active females younger than 25 years and in older women with high-risk behaviors is an important strategy in identifying patients with or at risk for PID and initiating early treatment. […] While antimicrobial therapy is highly effective, the focus of practitioners efforts should be to prevent long-term reproductive sequelae associated with PID.

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