Pelvic inflammatory disease refers to infection of the genital tract above the internal OS. The common manifestations include fever, lower abdominal tenderness, cervical excitation tenderness, adnexal tenderness and abnormal vaginal discharge. It is caused by polymicrobial organisms such as gonococcus, chlamydia trachomatis, Mycoplasma hominis and other intestinal and vaginal normal flora.
Diagnosis:
Clinical: Fever, lower abdominal tenderness, and cervical excitation tenderness, adnexal tenderness and abnormal vaginal discharge
Laboratory: leucocytosis with neutrophilia and raised ESR
Culture and sensitivity of blood, pus, or vaginal discharge
Vaginal/Swab: evidence of cervicitis
Ultrasonography: Evidence of inflammatory collection
Laparascopy: visualization of hyperemic tubes, purulent discharge
Laparatomy: Abscess collection or inflammation of the pelvic organs
Treatment:
Drug treatment
1. ACUTE PID Out patient treatment
First line:
Ceftriaxone, 250 mg IM stat
Doxycyclline, 100 mg p.o. 12 hrly. (For S/E, C/I and dosage forms, see page 8)
PLUS
Metronidazole, 500mg p.o. 6hrly for a week. (For S/E, C/I and dosage forms, see page 1)
2. ACUTE PID Inpatient treatment
Admission criteria includes Parity, age, pregnancy, HIV, history of infertility and the facility
a. Drug treatment
Requires hospitalization and administration of IV medication until 48 hrs after the fever has subsided, then to be administered as p.o /i.m medication for 10-14 days.
First line:
Ampicilline, 500 - 1000 mg i.v. 6 hourly, followed by 500 mg p.o. 6 hrly (For S/E, C/I, D/I and Dosage forms, see page 7)
PLUS
Gentamicin, 80 mg i.v., 8 hourly followed by i.m. injection of similar dose
(For S/E, C/I, D/I and Dosage forms, see page 25)
PLUS
Chloramphenicol/ Metronidazole, 500 mg, i.v., 8 hourly followed by 500 mg p.o. 6 hrly
(For S/Es, C/Is, D/Is and Dosage forms: see page 11/1)
Alternative
Ceftriaxone, 1 g/day, i.v. (For S/E, C/I, D/I and Dosage forms, see page5)
PLUS
Gentamicin, 80 mg, 8 hourly i.m.
(For S/E, C/I, D/I and Dosage forms, see page 25)
PLUS
Metronidazole, 500mg 8 hourly p.o.
(For S/Es, C/Is, D/Is and Dosage forms: see page 1)
OR
Clindamycin, 450 - 600 mg, i.v. 8 hourly
(For S/E, C/I, D/I and Dosage forms, see page 30)
AND/OR
Doxycycline, 100 mg p.o. 12 hourly until 48 hrs after the fever has subsided (For S/E, C/I, D/I and Dosage forms, see page 8)
b. Surgical treatment
Laparatomy and drainage of abscess, salpingo-opherectomy, Colpotomy, Hysterectomy with or without salpingo-opherectomy
