Pelvic inflammatory disease

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It is a infection of upper female genital tract (cervix, uterus, fallopian tubes and ovaries) due to pathogenic microorganisms mainly by Neisseria gonorrhoeae and Neisseria chlamydia.

Diagnosis:

  • By polymerase chain reaction test of cervical specimens for N.gonorrhoeae and chlamydia

Prescription of a female contains

Antibiotics – penicillins, cephalosporins, fluoroquinolones, metronidazole

Check for symptoms

  • Pain in lower abdomen
  • Cervical discharge
  • Irregular vaginal bleeding
  • Painful urination and intercourse
  • Pain in rectum
  • Fever (rare)

Dose and dosage:

Parenteral:

Regimen A: Cefotetan 2 g IV every 12 h / Cefoxitin 2 g IV every 6 h + Doxycycline 100 mg orally or IV every 12 h

Regimen B: Clindamycin  900 mg IV every 8 h + Gentamicin 2 mg/kg (loading dose) IV or IM, followed by a maintenance dose (1.5 mg/kg) every 8 h

Alternative: Ampicillin / sulbactam 3 g IV every 6 h + Doxycycline 100 mg orally or IV every 12 h

 

Oral Adminstration:

  • Ceftriaxone -250 mg IM in a single dose + Doxycycline 100 mg orally twice/day for 14 days with or without  Metronidazole -500 mg twice/day for 14 days  
  •                                                               or
  • Cefoxitin  2 g IM in a single dose with probenecid 1 g orally given in a single dose + Doxycycline 100 mg orally twice/day for 14 days with or without  Metronidazole  500 mg twice/day for 14 days                                                                        or  
  • Ceftizoxime / cefotaxime +  Doxycycline  100 mg orally twice/day for 14 days with or without  Metronidazole  500 mg twice/day for 14 days.
  • Levofloxacin 500 mg once/day or Ofloxacin  400 mg twice/day for 14 days with or without  Metronidazole  500 mg twice/day for 14 days.

Contraindications:

  • Hypersensitivity
  • Person is allergic to specific antibiotic
  • Levofloxacin, ciprofloxacin – pregnancy

Complications:

Untreated PID may lead to infertility, ectopic pregnancy and chronic pelvic pain

Counselling on side effects:

  • Pain at site of injection
  • Diarrhoea
  • Rashes due to hypersensitivity

Controlling triggering factors:

  • Douching
  • Bacterial vaginitis
  • Sexually transmitted diseases
  • Multiple sex partners
  • Black race                                                  

Counselling lifestyle management:

  • Good perineal hygiene
  • Avoid frequent douching

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