Pelvic Inflammatory Diseases(PID)

Diagnosis: 2002 CDC Criteria

A.       Major Criteria (Required)

1.       Uterine or adnexal tenderness to palpation or

2.       Cervical motion tenderness

B.       Minor Criteria (Supporting, but not required)

1.       Fever >101 F (38.3 C)

2.       Abnormal discharge per vagina

3.       WBCs on  Gram stain or Saline of cervix swab

4.       Gonorrheaor Chlamydia testing positive

5.       Increased sedimentation rate or C-Reactive Protein.

6.       PID findings on diagnostic study (see below)

Differential Diagnosis

A.       Ruptured Ovarian Cyst.
B.       Ectopic Pregnancy
C.      Appendicitis
D.      Urinary Tract Infection
E.       Ovarian Torsion

Management Outpatient

A.       Step 1: Initial Treatment at Diagnosis

1.       Cefoxitin 2g IM and  Probenecid 1g PO or

2.       Ceftriaxone 250 mg IM for 1 dose or

3.       Other third generation  Cephalosporin (e.g Cefotaxime)

B.       Step 2: Outpatient 14 day antibiotic course

1.       Select general antibiotic coverage

a.       Ofloxacin 400 mg PO bid for 14 days (95% cure) or

b.       Levofloxacin 500 mg PO bid for 14 days or

c.       Doxycycline 100 mg PO bid for 14 days (75% cure)

2.       Add anaerobic coverage (consider)

a.       Clindamycin 450 mg PO qid for 14 days OR

b.       Metronidazole 500 mg PO bid for 14 days

Management Inpatient

A.       Hospitalization Indications

1.       Toxic appearance

2.       Unable to take oral fluids

3.       Unclear diagnosis

a.       Appendicitis

b.       Ectopic Pregnancy

c.       Ovarian torsion

4.       Pelvic abscess

5.       Pregnancy

6.       HIV positive

7.       Adolescents

8.       Outpatient treatment failure

9.       Unreliable patient

B.       Inpatient treatment Regimens

1.       General

a.       Treat for at least 48 hours IV

2.       Regimen A

a.       Cefoxitin 2g IV q6h OR Cefotetan 2g IV q12h and

b.       Doxycycline 100 mg PO or IV q12h

3.       Regimen B

a.       Clindamycin 900 mg IV q8h and

b.       Gentamicin 2 mg/kg IV load, then 1.5 mg/kg IV q8h

i.         Alternative: Conversion to single daily dosing

4.       Discharge Regimen (after IV antibiotics above)

a.       See Outpatient Management Step 2 above