Active Ingredients: Azithromycin
The European guideline for the management of pelvic inflammatory disease contains similar recommendations. As alternative regimens, the European guideline suggests i.
They further note that ofloxacin and moxifloxacin should be avoided in patients who are at high risk of gonococcal PID due to increasing quinolone resistance by N. Oral Treatment Over the past 20 years, a new paradigm has emerged with a dramatic shift from hospital-based parenteral antibiotic regimens to oral ambulatory-based regimens.
Initially, this shift was largely driven by the emergence of managed care and other economic factors without the benefit of clinical studies demonstrating that oral therapy was as effective as parenteral regimens, especially for prevention of long-term sequelae.
The PEACH study has provided evidence supporting the use of oral regimens on an ambulatory basis for the treatment of mild and moderately severe acute PID.
Of most significance, PEACH not only assessed short-term but also long-term outcomes for over 800 patients 398 inpatient and 410 outpatient with mild-to-moderately severe PID.
At a mean followup of 35 months, the pregnancy rates were 42. Long-term outcomes including infertility, ectopic pregnancy, recurrent PID, and chronic pelvic pain were also similar in both groups.
However, as emphasized by Haggerty and Ness, despite high rates of clinical cure and eradication of N.
However, the clinical significance of this finding is not clear. In previous studies we have shown that ongoing subclinical PID as defined by histologic acute endometritis is frequently present in women with untreated lower genital tract infections, and that persistent endometrial infection with C.
Moreover, women with persistent endometrial M. As noted by the CDC, outpatient oral therapy can be considered for treatment of women with mild-to-moderately severe acute PID. The oral regimens listed in Table 3 provide coverage against the major etiologic agents of acute PID.
Which of the cephalosporins is the optimum selection is unclear. On the one hand cefoxitin has better anaerobic coverage, while ceftriaxone has better coverage against N.
The extent of efficacy against anaerobic bacteria with a single dose of cefoxitin is questionable. However, in the PEACH study single dose cefoxitin was effective in obtaining clinical response. In addition, metronidazole will effectively treat bacterial vaginosis, which as noted above is frequently associated with PID.