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

ABSTRACT 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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    • "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; 2012:325108. 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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    ABSTRACT: Pelvic inflammatory disease (PID) is one of the most common infections seen in nonpregnant reproductive-age women. It is a major public health problem associated with substantial medical complications (e.g., infertility, ectopic pregnancy, and chronic pelvic pain) and healthcare costs. Prevention of these long-term sequelae requires treatment strategies that are based on the microbiologic etiology of acute PID. Objective: To determine appropriate antimicrobial regimens for the treatment of acute PID based on published literature. Clinical trials published since 2002 were assessed conducting a systematic search of the literature on the treatment of acute PID using PubMed (National Library of Congress). The search was limited to articles written in English and published from 1 January 2002 to 30 June 2008. Acute PID is a polymicrobic infection caused by both sexually transmitted organisms (primarily Neisseria gonorrhoeae and Chlamydia trachomatis) and microorganisms found in the endogenous flora of the vagina and cervix. The latter include anaerobic bacteria and facultative bacteria, many of which are associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, may also be implicated in the etiology of acute PID. Because of this polymicrobial nature, currently available evidence, as well as recommendations by the CDC, support the use of broad-spectrum regimens (oral or parenteral) that provide adequate coverage against these microorganisms.
    Expert Opinion on Pharmacotherapy 05/2009; 10(5):823-37. DOI:10.1517/14656560902823816 · 3.53 Impact Factor
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