Pelvic inflammatory disease: Difference between revisions

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# R/O other intra-abd pathology (consider CT, UA, labs)  
# R/O other intra-abd pathology (consider CT, UA, labs)  


==Treatment==
== Treatment ==
===Outpatient===


1) Ceftriaxone (250 mg IM x 1)
=== Outpatient ===


+ doxycycline (100mg PO BID x 14 days)
1) Ceftriaxone (250 mg IM x 1)  


+/- metronidazole (500mg PO BID x 14 days)
+ doxycycline (100mg PO BID x 14 days)  


OR
+/- metronidazole (500mg PO BID x 14 days)


2) Cefoxitin (2g IM x 1)
OR


+ probebenecid (1gm PO x 1)
2) Cefoxitin (2g IM x 1)  


+ doxycycline (100mg PO BID x 14 days)
+ probebenecid (1gm PO x 1)  


+/- metronidazole (500mg PO BID x 14 days)
+ doxycycline (100mg PO BID x 14 days)  


OR
+/- metronidazole (500mg PO BID x 14 days)
 
OR  


3) 3-gen cephalosporin [cefotaxime (1gm IM x1) OR ceftizoxime (1gm IM x 1)
3) 3-gen cephalosporin [cefotaxime (1gm IM x1) OR ceftizoxime (1gm IM x 1)  


+ doxycycline (100mg PO BID x 14 days)
+ doxycycline (100mg PO BID x 14 days)  


+/- metronidazole (500mg PO BID x 14 days)  
+/- metronidazole (500mg PO BID x 14 days)  


^Metronidazole based upon assessment of risk for anaerobs. Consider in:
^Metronidazole based upon assessment of risk for anaerobs. Consider in:  
# Pelvic abscess
 
# Proven or suspected infection Trichomonas vaginalis or bacterial vaginosis
#Pelvic abscess  
# History of gynecological instrumentation in the preceding two to three weeks.  
#Proven or suspected infection Trichomonas vaginalis or bacterial vaginosis  
#History of gynecological instrumentation in the preceding two to three weeks.


===Inpatient===
=== Inpatient ===
1) Cefotetan 2gm IV q12h OR cefoxitin 2mg IV q6h    
 
1) Cefotetan (2gm IV q12h) OR (cefoxitin 2mg IV q6h)
 
+ doxy (100mg IV/PO q12hOR2)
 
OR


+ doxy 100mg IV/PO q12hOR2) Clinda 900mg IV q8h    
2) Clinda (900mg IV q8h)


+ 4.5 mg/kg QD    
+ gentamycin 3-5 mg/kg QD  


+ (after) doxy 100mg PO BID x 14dy  
+ (after) doxy 100mg PO BID x 14dy  


^Rising levels of fluoroquinolone resistance, use them only where prevalence of resistant GC <5%.
^Rising levels of fluoroquinolone resistance, use them only where prevalence of resistant GC &lt;5%.  


^^Treat all partners that had sexual contact with the patient during the previous 60 days prior to the patient's onset of symptoms (advise to avoid sex until treated)
^^Treat all partners that had sexual contact with the patient during the previous 60 days prior to the patient's onset of symptoms (advise to avoid sex until treated)

Revision as of 18:00, 7 July 2011

Background

Commonly begins as cervical infection (cervicitis) with gonorrhea or chlamydia

Diagnosis

  1. Pelvic pain (90%)
  2. Constitutional sx-Vaginal discharge (75%)
  3. Abnl pelvic exam (60%)
  4. Vaginal bleeding (40%)

CDC Criteria^^

  1. Cervical motion tenderness (CMT)
  2. OR, B. Pelvic/adenexal TTP (in pt with no other identifiable cause)

Additional Criteria

  1. Fever
  2. WBC >10k
  3. Abnl cervical discharge (50%)
  4. WBC on wet mounte) GC/Chlamy

^^CDC Criteria are sensitive, but not specific (i.e. many intr-abominal processes have CMT)

Work-Up

  1. Upreg (negative)
  2. Pelvic exam (send GC/Chlamy, wet mount)
  3. Pelvic US if toxic (r/o TOA)
  4. R/O other intra-abd pathology (consider CT, UA, labs)

Treatment

Outpatient

1) Ceftriaxone (250 mg IM x 1)

+ doxycycline (100mg PO BID x 14 days)

+/- metronidazole (500mg PO BID x 14 days)

OR

2) Cefoxitin (2g IM x 1)

+ probebenecid (1gm PO x 1)

+ doxycycline (100mg PO BID x 14 days)

+/- metronidazole (500mg PO BID x 14 days)

OR

3) 3-gen cephalosporin [cefotaxime (1gm IM x1) OR ceftizoxime (1gm IM x 1)

+ doxycycline (100mg PO BID x 14 days)

+/- metronidazole (500mg PO BID x 14 days)

^Metronidazole based upon assessment of risk for anaerobs. Consider in:

  1. Pelvic abscess
  2. Proven or suspected infection Trichomonas vaginalis or bacterial vaginosis
  3. History of gynecological instrumentation in the preceding two to three weeks.

Inpatient

1) Cefotetan (2gm IV q12h) OR (cefoxitin 2mg IV q6h)

+ doxy (100mg IV/PO q12hOR2)

OR

2) Clinda (900mg IV q8h)

+ gentamycin 3-5 mg/kg QD

+ (after) doxy 100mg PO BID x 14dy

^Rising levels of fluoroquinolone resistance, use them only where prevalence of resistant GC <5%.

^^Treat all partners that had sexual contact with the patient during the previous 60 days prior to the patient's onset of symptoms (advise to avoid sex until treated)

Disposition

Admit for:

  1. TOA, Fitz-Hugh-Curtis
  2. Sepsis/peritonitis
  3. Unable to tol POs
  4. Failed outpt Rx

Complications

  1. TOA/sepsis
  2. Infertility
  3. Ectopic
  4. Chronic pelvic pain

Source

CDC 2010, KajiQuestions

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