Active Ingredient: Ciprofloxacin
With the emergence of quinolone-resistant N.
They note that in situations where single dose parenteral cephalosporin is not feasible, use of fluoroquinolones levofloxacin 500 mg orally once a day or ofloxacin 400 mg orally twice a day for 14 days with or without metronidazole 500 mg twice daily for 14 days can be considered if community prevalence and individual risk for gonorrhea are low.
If this approach is selected, the CDC stresses that diagnostic tests for N. Culture is the preferred test.
With quinolone-resistant N. If use of a cephalosporin is not feasible, azithromycin 2 grams as a single dose can be added to a quinolone-based PID treatment regimen.
Patients treated with an oral regimen should demonstrate substantial clinical improvement within three days following initiation of treatment. When patients fail to improve within this window, hospitalization is usually required for additional diagnostic tests e.
Hospitalization for Treatment of Acute PID While in the past, and to a lesser extent today, some clinicians have recommended that all patients with PID be hospitalized for parenteral antibiotics and bed rest, the PEACH study clearly demonstrated that in women with mild-to-moderately severe PID, outpatient oral therapy results in similar short- and long-term clinical outcomes as inpatient therapy.
As a result, the CDC notes that a decision regarding the need for hospitalization should be based on the judgment of the health-care provider and whether the patient meets any of the CDC suggested criteria for hospitalizations Table 5.
The European guideline concurs with these recommendations.
Table 5 Suggested criteria for hospitalization for treatment of acute PIDa. Limited studies have demonstrated that pregnant women with PID have high rates of fetal wastage and preterm delivery, supporting the appropriateness of hospitalization.
Several previous criteria for hospitalization have been removed from the current suggestions.
The absence of data to support benefit from hospitalization for adolescent girls with PID led the CDC to not list adolescence among the criteria for hospitalization and to suggest that a decision to hospitalize adolescents with PID should be based on the same criteria used for older women.
In fact, subanalysis of the outcome data of the PEACH study stratified by age demonstrated that fertility outcomes of the adolescents were similar in the inpatient and outpatient treatment arms. However, some clinicians continue to advocate that all adolescents and never pregnant young women should be hospitalized for treatment.
They argue that adolescence is a proxy for poor compliance, high-risk sexual activity, delayed care, and high antimicrobial failure rates. Whereas the presence of HIV infection or immunosuppression has previously been an indicator for hospitalization and parenteral therapy, currently it is recommended that HIV-positive women with acute PID can be treated similarly to HIV-negative women.
As noted by Walker and Wiesenfeld, there does not exist any data to indicate that selection of treatment regimens should be influenced by the presence of an IUD.
This was primarily based on concerns that as a foreign body, removal of the IUD enhanced clinical response.
Only a few studies have addressed this issue and the results are conflicting.
In a small randomized study of 46 women in Sweden, Soderberg, and Lindgren reported no differences in response to treatment whether the IUD was removed or left in place.
Reprinted with permission from Walker and Sweet.
Table 4 Clinical and microbiologic cure rates for pelvic inflammatory disease treatment regimens.