Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial.
OBJECTIVE
Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal infection. Although most women with pelvic inflammatory disease are treated as outpatients, the effectiveness of this strategy remains unproven.


METHODS
We enrolled 831 women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease into a multicenter randomized clinical trial of inpatient treatment initiated by intravenous cefoxitin and doxycycline versus outpatient treatment that consisted of a single intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory disease, chronic pelvic pain, and ectopic pregnancy.


RESULTS
Short-term clinical and microbiologic improvement were similar between women randomized to the inpatient and outpatient groups. After a mean follow-up period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients and 41.7% for inpatients). There were also no statistically significant differences between outpatient and inpatient groups in the outcome of time to pregnancy or in the proportion of women with pelvic inflammatory disease recurrence, chronic pelvic pain, or ectopic pregnancy.


CONCLUSIONS
Among women with mild-to-moderate pelvic inflammatory disease, there was no difference in reproductive outcomes between women randomized to inpatient treatment and those randomized to outpatient treatment.
Ness
Roberta B
RB
University of Pittsburgh, Graduate School of Public Health, Pa 15261, USA.
Soper
David E
DE
Holley
Robert L
RL
Peipert
Jeffrey
J
Randall
Hugh
H
Sweet
Richard L
RL
Sondheimer
Steven J
SJ
Hendrix
Susan L
SL
Amortegui
Antonio
A
Trucco
Giuliana
G
Songer
Thomas
T
Lave
Judith R
JR
Hillier
Sharon L
SL
Bass
Debra C
DC
Kelsey
Sheryl F
SF
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000592:standards*; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002440:Cefoxitin / Q000008:administration & dosage / Q000627:therapeutic use*; D002513:Cephamycins / Q000008:administration & dosage / Q000627:therapeutic use*; D004318:Doxycycline / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D018873:Pregnancy Rate; D012720:Severity of Illness Index
D000900:Anti-Bacterial Agents; D002513:Cephamycins; D002440:Cefoxitin; D004318:Doxycycline