2012 European guideline for the management of pelvic inflammatory disease

Copenhagen University Hospital Hvidovre, Hvidovre, Capital Region, Denmark
International Journal of STD & AIDS (Impact Factor: 1.05). 11/2007; 18(10):662-6. DOI: 10.1258/095646207782193911
Source: PubMed


Pelvic inflammatory disease (PID) remains one of the most important consequences of sexually transmitted infections (STIs) resulting in severe morbidity and acting as the economic justification for STI screening programmes. Early and appropriate therapy has the potential to significantly reduce the long-term complications of PID, and these evidence-based guidelines provide advice on the management of pelvic infection including the use of appropriate antimicrobial regimens.

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    • "Parenteral treatment should be continued for at least 24 h after clinical improvement [1] [3]. Most PID studies have evaluated a 10–14-day course of treatment and this is the length of therapy currently recommended [1]. Treatment of acute PID typically has a response rate of 90–95% as assessed by resolution of acute symptoms but unfortunately there is a poor correlation between short-term response and long-term sequelae such as infertility [26] "
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    ABSTRACT: Pelvic inflammatory disease (PID) is a gynaecological inflammatory disorder with a high incidence that can lead to sequelae such as infertility, ectopic pregnancy and chronic pelvic pain. The International Union against Sexually Transmitted Infections (IUSTI) and the US Centers for Disease Control and Prevention (CDC) have issued treatment recommendations for the management of PID. The purpose of this review is to summarise the available evidence for the use of IUSTI- and CDC-recommended antibiotic therapies for PID. The main differences between recommendations concern alternative regimens for inpatient treatment and the use of oral moxifloxacin as an alternative outpatient regimen in the IUSTI guidelines. There is evidence supporting the use of the recommended antibiotic regimens, although with some variation in reported cure rates. This variation can be explained, in part, by the different diagnostic and evaluation criteria used in different trials. Adverse events that require discontinuation of antibiotic therapy are rarely observed. The main limitation of the current available evidence is the short-term follow-up, which does not allow full evaluation of the risks of long-term sequelae. © 2015 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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    • "Pelvic inflammatory disease (PID), particularly mild-to-moderate disease, can be difficult to diagnose as the symptoms and signs are often nonspecific, and there is no gold standard that confirms the diagnosis [1] [2] [3] [4]. Because the consequences of untreated PID may be severe, current clinical guidelines recommend that practitioners have a high index of suspicion for the diagnosis of PID and a low threshold for empirical treatment [5] [6] [7] [8]. Clinical guidelines outline the symptoms and signs of PID and likely causative organisms in different patient populations, appropriate diagnostic tests, and empirical broad-spectrum antibiotics that are available and appropriate, given local considerations regarding antibiotic resistance and whether the PID was thought to be sexually acquired, postpartum or postprocedural. "
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    ABSTRACT: Background: Evidence suggests adherence to clinical guidelines for pelvic inflammatory disease (PID) diagnosis and management is suboptimal. We systematically reviewed the literature for studies describing strategies to improve the adherence to PID clinical guidelines. Methods: The databases MEDLINE and EMBASE, and reference lists of review articles were searched from January 2000 to April 2012. Only studies with a control group were included. Results: An interrupted time-series study and two randomised controlled trials (RCTs) were included. The interrupted time-series found that following a multifaceted patient and practitioner intervention (practice protocol, provision of antibiotics on-site, written instructions for patients, and active followup), more patients received the recommended antibiotics and attended for followup. One RCT found a patient video on PID self-care did not improve medication compliance and followup. Another RCT found an abbreviated PID treatment guideline for health-practitioners improved their management of PID in hypothetical case scenarios but not their diagnosis of PID. Conclusion: There is limited research on what strategies can improve practitioner and patient adherence to PID diagnosis and management guidelines. Interventions that make managing PID more convenient, such as summary guidelines and provision of treatment on-site, appear to lead to better adherence but further empirical evidence is necessary.
    Infectious Diseases in Obstetrics and Gynecology 08/2012; 2012(3):325108. DOI:10.1155/2012/325108
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    • "In the past PID was believed to be a monoetiologic infection , primarily caused by Neisseria gonorrhoeae. Today, the polymicrobic etiology of PID is well established and has led to utilization of broad spectrum antimicrobial regimens for treatment of acute PID [1] [2] [17] [18]. "
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    ABSTRACT: Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
    Infectious Diseases in Obstetrics and Gynecology 12/2011; 2011(1064-7449):561909. DOI:10.1155/2011/561909
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