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. 

In This Article

Mild-to-moderate PID

Most cases of PID (diagnosed in women with evidence of lower genital tract inflammation and pelvic organ tenderness but no mass) have mild-to-moderate disease. These patients can safely be treated as outpatients. Treatment of PID should provide high rates of clinical and microbiologic cure for N. gonorrhoeae and C. trachomatis, even in the presence of negative endocervical screening for these organisms. It should also provide coverage for the polymicrobial flora found associated with BV.[8,11–14]

The Pelvic Inflammatory Disease Evaluation and Clinical Health Randomized Trial (PEACH) provides the best guidance regarding the antibiotic therapy of women with mild-to-moderate PID. In this large, multicentered, prospective randomized trial, a single dose of intramuscular cefoxitin administered with probenecid, followed with 14 days of oral doxycycline, resulted in a similar short-term cure rate (both >98%) in outpatients when compared with multiple parenteral doses of cefoxitin and oral doxycycline in inpatients. There was no difference in the long-term outcomes of fertility and ectopic pregnancies between the two groups. Although two-thirds of the PEACH participants had BV, concurrent metronidazole was not administered. This suggests that a single dose of cefoxitin, which has good activity against Gram-negative anaerobes, and multiple doses of doxycycline, despite suboptimal activity against anaerobic bacteria, are sufficient for clinical cure and apparently do not adversely affect long-term outcome comparatively.[15] The CDC-recommended regimens allow substitution of cefoxitin with other extended-spectrum cephalosporins such as ceftriaxone, ceftizoxime and cefotaxime. The CDC-recommended regimens also allow the clinician discretion to extend the anaerobic coverage by prescribing oral metronidazole in addition to the aforementioned doxycycline (Box 4).


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