PID: In-Patient Treatment

Clinical Description

• A triad of lower abdominal pain, abnormal vital signs (particularly fever and tachycardia) and peritonism (guarding or rebound tenderness with cervical motion and adnexal tenderness).
• Patients additionally have positive risk screen and abnormal vaginal discharge

Signs and Symptoms

• Failure to respond to syndromic treatment regime within 72 hours
• Presence of tender pelvic mass which may be an abscess or an ectopic pregnancy
• History or suspicion of recent induced abortion, delivery, or miscarriage
• Active vaginal bleeding
• Missed, overdue or delayed period

Pregnancy

• Heavy menstrual bleeding
• Vomiting

Note: The patient should be admitted

Pharmacological

If deranged vital signs, dehydration etc.

• Give IV fluids
• Offer analgesia
• Parenteral antibiotics.

1st line Ceftriaxone 2g IV 24 hourly metronidazole 500mg IV 8 hourly alternative 1st line Gentamicin 240mg IV 24 hourly

Metronidazole 500mg IV 8 hourly

Ampicillin 1g IV 8 hourly

• When improved and able to swallow switch to oral antibiotics:
• Doxycycline 100mg 12 hourly and
• Metronidazole 400mg 8 hourly for 10 days
• Analgesic
• If pain is severe:
• Give Pethidine 100 mg IM then PRN

Notes:

• Post abortal sepsis and puerperal sepsis may present as acute PID. If these are recognized, the following must be done:
• Admit and treat with parenteral antibiotic therapy.
• If retained products of conception suspected, evacuate the uterus within 12 hours of antibiotic therapy regardless of the patient's temperature
• Provide supportive care such as blood transfusion, iv fluids and closely monitor vital signs.