title: Recommendations and rationale for the treatment of pelvic inflammatory disease.
abstract: Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo-ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.
authors.affiliation: Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
authors.forename: Oluwatosin
authors.initials: O
authors.lastname: Jaiyeoba
authors.forename: Gweneth
authors.initials: G
authors.lastname: Lazenby
authors.forename: David E
authors.initials: DE
authors.lastname: Soper
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002487:Centers for Disease Control and Prevention, U.S.; D002690:Chlamydia Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D002692:Chlamydia trachomatis / Q000187:drug effects; D005260:Female; D006069:Gonorrhea / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D006801:Humans; D009175:Mycoplasma Infections / Q000188:drug therapy / Q000382:microbiology / Q000503:physiopathology; D045704:Mycoplasma genitalium / Q000187:drug effects; D009344:Neisseria gonorrhoeae / Q000187:drug effects; D000292:Pelvic Inflammatory Disease / Q000188:drug therapy* / Q000382:microbiology* / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D016032:Randomized Controlled Trials as Topic; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents