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Pelvic inflammatory disease - Management
What follow up should I arrange?
- Review within 72 hours.
- There should be demonstrable clinical improvement (such as a reduction in abdominal tenderness, and a reduction in uterine, adnexal, and cervical motion tenderness).
- If there has been little or no improvement, consider admitting to hospital or review the diagnosis.
- Check the antibiotic sensitivities from swab results. Even if swabs are negative, treatment should be continued.
- If metronidazole is not tolerated it may be discontinued in women with mild or moderate pelvic inflammatory disease (PID) as it has uncertain efficacy in this group.
- Consider further review at about 4 weeks in order to:
- Check compliance with, and response to, treatment.
- Confirm that sexual contacts have been screened and treated.
- Discuss the potential sequelae of PID.
- Tests of cure are only necessary if:
- Symptoms persist after treatment.
- Antibiotic resistance is likely (particularly in cases of gonorrhoea).
- Poor compliance with treatment is suspected, or the treatment has not been tolerated.
- There is a possibility of reinfection (that is, further contact with untreated partners).
- Sensitivity testing has not been undertaken or has indicated resistance.
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