Treatment

Treatment of PID is aimed at relieving acute symptoms, eradicating current infection, and minimizing the risk of long-term sequelae. There is no clear role for anti-inflammatory drugs per se at this time, but effective analgesia should be administered. 1°.!Z Therapy initiated in the emergency department must include intravenous hydration and empiric, broad-spectrum antibiotics to cover the full range of likely organisms. All regimens should be effective against anaerobes, gram-negative facultative organisms, and streptococci, as well as N. gonorrheae and C. trachomatis. A variety of inpatient regimes with broad spectrum coverage have been shown to be effective in eliminating acute symptoms and to effect microbiologic cure (84 to 98 percent cure rates). It is less clear that these regimens can reduce long-term sequelae. However, evidence suggests that long-term outcomes are improved if antibiotics are begun within 48 h of symptom onset. Current CDC

recommendations are shown in Table 105-2. and T.a.b.l.,e 1.,05.-.?. Few investigators have assessed and compared parenteral and oral antibiotic regimens, or inpatient versus outpatient regimens, with regard to documented elimination of endometrial and tubal infection.1 Ji Several new regimens, including azithromycin, appear promising in terms of adequacy of coverage and potential patient compliance but are not currently recommended by the CDC because of lack of data. However, many ED practitioners have already included this in their armamentarium.

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