Severe PID & TOA
Women with clinically severe PID or who meet the criteria noted in Box 3, or both, should be considered for hospitalization and inpatient parenteral therapy. These patients are most likely have non-chlamydial polymicrobial PID or, less commonly, acute gonococcal PID. Imaging should be considered in hospitalized patients to evaluate for other diseases and/or abscess. Women hospitalized with severe PID may have TOA, and imaging with pelvic ultrasonography or computed tomography is recommended. Although 75% of women with TOA will respond to antibiotic therapy alone, some will fail to respond and require surgical intervention. The need for surgical intervention is related to the size of the TOA with 60% of those with abscesses 10 cm or greater in diameter, 30% of those measuring 7–9 cm, and only 15% of those 4–6 cm in diameter needing surgery. Patients who fail to respond to antibiotic treatment within 48–72 h, as characterized by persistent fever and increasing leukocytosis, should be considered for surgical drainage. Drainage of TOA can be effected by laparotomy, laparoscopy or image-guided percutaneous routes.
Proper antimicrobial therapy of pelvic abscesses includes an antibiotic regimen with activity against anaerobic bacteria such as Bacteroides fragilis and Prevatella bivius, which are β-lactamase producing. In addition, the antimicrobial regimen should have good coverage for E. coli, a common and predominant isolate from patients with ruptured TOA and a well-recognized cause of Gram-negative sepsis. Regimens recommended for this clinical scenario include the combination regimens of clindamycin with gentamicin, cefotetan or cefoxitin with doxycycline, and ampicillin/sulbactam with doxycycline (Box 5).
Expert Rev Anti Infect Ther. 2011;9(1):61-70. © 2011 Expert Reviews Ltd.
Cite this: Recommendations and Rationale for the Treatment of Pelvic Inflammatory Disease - Medscape - Jan 01, 2011.