Pelvic inflammatory disease. Key treatment issues and options

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 broadspectrum 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. (JAMA. 1991;266:2605-2611)