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Pelvic inflammatory disease - Management
Basis for recommendation
These recommendations are based on expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009], the British Association for Sexual Health and HIV [BASHH, 2005a], and the Department of Health and Human Services — Centres for Disease Control and Prevention [CDC, 2006].
Admission, if the woman is failing to improve
- Failure to improve substantially after 72 hours suggests a need for further investigation, intravenous therapy, or surgical intervention [BASHH, 2005a].
Discontinuation of metronidazole if it is not tolerated
- Although anaerobes may have a role in the pathogenesis of pelvic inflammatory disease (PID), they are probably of more importance in women who have severe PID. Expert opinion in guidelines from the Royal College of Obstetricians and Gynaecologists [RCOG, 2009], the British Association for Sexual Health and HIV [BASHH, 2005a], and the European guideline for the management of pelvic inflammatory disease [Ross et al, 2008], based on studies which have not included metronidazole but have had good outcomes, suggests that if the PID is not severe and metronidazole is not tolerated then it may be stopped.
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