PID Treatment Guidelines for Pelvic Inflammatory Disease
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Pelvic inflammatory disease (PID) is a spectrum of inflammatory disorders involving the female reproductive organs including the endometrium, uterus, fallopian tubes, and ovaries. PID can cause tubal blocks, infertility, ectopic pregnancy, and chronic pelvic pain. Risk factors include sexually transmitted diseases, young age of first intercourse, multiple sexual partners, and intrauterine devices. Diagnosis involves examining for lower abdominal pain, cervical motion tenderness, and uterine or adnexal tenderness. Treatment follows CDC guidelines and involves inpatient intravenous antibiotics like doxycycline or clindamycin before continuing oral antibiotics for 14 days.
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PID Treatment Guidelines for Pelvic Inflammatory Disease
- 1. PELVIC INFLAMMATORY DISEASE Dr. Richa Katiyar IVF and Infertility Specialist, New Delhi, India Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 2. PID Spectrum of inflammatory disorders involving endometrium, uterus, fallopian tubes and ovary. Endometritis Salpingitis Tubo-ovarian Abscess Pelvic peritonitis Generalised peritonitis Septicaemia Late sequelae: Tubal blocks, infertility, Ectopic pregnancy, Chronic pelvic pain Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 3. PID – Risk Factors STDs – Strong association with PID Age of 1st intercourse No. of sexual partners Frequency of coitus IUCD (3 to 4 fold increase)- multifilament string. Surgical procedures (ascending infection) e.g. D&C, MTP, HSG, Hysteroscopy Previous acute PID Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 4. PID – Diagnosis CDC – 2002: Minimum criteria Lower abdominal pain Cervical motion tenderness Uterine/adnexal tenderness Additional Criteria: Fever Abnormal mucopurulent cervical/vaginal discharge ESR C Reactive Protein Leukocytosis WBC on saline microscopy of vaginal secretions Lab diagnosis of cervical infection with N. gonorrhoea or C. trachomatis Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 5. PID – Diagnosis Specific criteria: Histopathologic evidence of endometritis TVS/MRI: thickened tube T.O. abscess/mass, free fluid in peritoneal cavity Laparoscopic evidence of PID Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 6. PID - Management Inpatient Parenteral treatment - CDC guidelines Regimen A Cefotetan 2gm I.V. 12 hrly OR Cefoxitin 2 gm I.V. 6 hrly + Doxy 100mg I.V. 12 hrly Continue for 24 hours after improvement, followed by Doxy 100 mg BD x 14 d oral + Metro/ Clindamycin (14 d) added if TO abscess Regimen B Clindamycin 900mg I.V. 8 hrly + Genta 2 mg/kg body wt. 8 hrly Continue for 24 hours after improvement, Continue Doxy 100mg BD x 14 d Or Clindamycin 450mg QID x 14 d Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com
- 7. PID - Management Inpatient Parenteral treatment - CDC guidelines Regimen A Cefotetan 2gm I.V. 12 hrly OR Cefoxitin 2 gm I.V. 6 hrly + Doxy 100mg I.V. 12 hrly Continue for 24 hours after improvement, followed by Doxy 100 mg BD x 14 d oral + Metro/ Clindamycin (14 d) added if TO abscess Regimen B Clindamycin 900mg I.V. 8 hrly + Genta 2 mg/kg body wt. 8 hrly Continue for 24 hours after improvement, Continue Doxy 100mg BD x 14 d Or Clindamycin 450mg QID x 14 d Dr. Richa Katiyar, Web: www.how-to-get-pregnant.in Email: dr.richa.katiyar@gmail.com