Recommendations and Rationale for the Treatment of Pelvic Inflammatory Disease

Oluwatosin Jaiyeoba; Gweneth Lazenby; David E Soper


Expert Rev Anti Infect Ther. 2011;9(1):61-70. 

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As mentioned previously, women with a clinical diagnosis of cervicitis often test positive for C. trachomatis, N. gonorrhoeae and T. vaginalis or have evidence of BV. It is known that up to 27% of these women will have histologic evidence of endometritis,[9] therefore we must be confident that the choice of antibiotic therapy for the treatment of cervicitis also covers endometritis (diagnosed in some women with mucopurulent cervicitis and no pelvic organ tenderness during bimanual exam). The antibiotic regimen should not only treat the potential pathogens noted but also result in a resolution of their endometritis. Fortunately, Eckert et al., showed that a short course of an oral antibiotic regimen consisting of single-dose cefixime 400 mg, single-dose azithromycin 1 g and metronidazole 500 mg twice daily for 7 days was highly effective (89%) in leading to the resolution of histologic endometritis (Box 2).[10] Metronidazole may be withheld if no evidence of BV or T. vaginalis is present.


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