Pelvic inflammatory disease. Key treatment issues and options
H. B. Peterson, C. K. Walker, J. G. Kahn, A. E. Washington, D. A. Eschenbach and S. Faro
Division of Reproductive Health, Centers for Disease Control, Atlanta, GA 30333.
OBJECTIVE.--To examine available data regarding optimal antimicrobial
therapy for pelvic inflammatory disease (PID) and to address selected
treatment issues confronting clinicians caring for women with PID. DATA
SOURCES.--Studies evaluated to help establish the Centers for Disease
Control's 1989 Sexually Transmitted Diseases Treatment Guidelines and other
reports published since 1985. A MEDLINE search of English-language
literature was conducted using the indexing terms "pelvic inflammatory
disease" or "pelvic infections" or "salpingitis" and "treatment". In
addition, abstracts and bibliographies of articles and books were reviewed.
STUDY SELECTION.--Studies were selected for detailed review if they
evaluated the effectiveness of an antimicrobial regimen for treatment of
PID. DATA EXTRACTION.--All studies were evaluated to determine the numbers
of women treated and the percentage with clinical or microbiologic evidence
of cure. DATA SYNTHESIS.--A variety of combination antimicrobial regimens
are highly effective in providing clinical and microbiologic evidence of
cure; few data are available to assess optimal therapy for prevention of
late sequelae. Because PID is polymicrobial in cause, recommended
antimicrobial regimens are broad-spectrum in coverage. CONCLUSIONS.--No
single agent that provides sufficient coverage is currently available.
Several combination regimens appear highly effective clinically even among
women with tubo-ovarian abscess formation. Uncertainties regarding the
effectiveness of antimicrobial therapy for prevention of late sequelae
complicate decisions regarding the choice among regimens and the
appropriateness of ambulatory treatment of women with PID. Pending better
data, hospitalization should be strongly considered, where feasible,
particularly for those women with PID desiring further childbearing. Sex
partners of all women with PID should be treated.
