Treatment Of Pelvic Inflammatory Disease Research Articles

"Effectiveness of Jinying capsule on pelvic inflammatory disease in patients with symptom pattern of damp and heat accumulation: a double-blinded, multicenter, randomized, placebo-controlled clinical trial".

To evaluate the therapeutic effectiveness and safety of Jinying capsule on pelvic inflammatory disease (PID) in patients with symptoms identified as the pattern of damp and heat accumulation in terms of Traditional Chinese Medicine (TCM). We conducted a double-blinded, multicenter, randomized, placebo-controlled clinical trial which included 155 patients diagnosed with PID and identified as symptom pattern of damp and heat accumulation. They were randomly divided into experimental group (n = 78) and control group (n = 77) according to a random number table. The treatment lasted for a period of 28 d. The experimental group was given Jinying capsules and oral levofloxacin plus oral metronidazole for first 7 d. They continued with Jinying capsules and levofloxacin placebo and metronidazole placebo for another 7 d. For the remaining 14 d, they continued with Jinying capsules only. Whereas, the control group was treated with oral levofloxacin and metronidazole and Jinying capsule placebo for the first 14 d in the same way as the experimental group and then continued with Jinying capsule placebo only for the remaining 14 d. The clinical efficacy was assessed using McCormack scale, TCM symptom pattern scores, physicochemical indexes including white blood cell and erythrocyte sedimentation rate, C-reaction protein, smear of vaginal discharge, and pelvic ultrasound. Comparing McCormack scale between both groups after treatment, the difference in curative effect between both groups was significant (P = 0.0269). The cure rate of the experimental group and control group is 76.32% and 59.46% respectively at week 4. Comparing TCM symptom pattern scores between both groups before and after treatment, the differences in total effective rate were both significant (P < 0.05). The curative effect rate of experimental group is 2.63% and 13.70% of the control group at week 1 (P = 0.0131), and 73.33% of the experimental group and 56.94% of the control group at week 4 (P = 0.0369). No significant differences were found between the two groups on the Physicochemical indexes (all P > 0.05). No adverse events or reactions occurred in the experimental groups. Jinying capsule can reduce the dosage of antibiotics needed for PID treatment, and improve the symptoms in PID patients.

Discussion on Clinical Efficacy of Levofloxacin Hydrochloride Combined With Fule Tablets in the Treatment of Pelvic Inflammatory Disease

Discussion on Clinical Efficacy of Levofloxacin Hydrochloride Combined With Fule Tablets in the Treatment of Pelvic Inflammatory Disease

A Need for Standardization of the Diagnosis and Treatment of Pelvic Inflammatory Disease: Pilot Study in an Outpatient Clinic in Quito, Ecuador.

Background Pelvic inflammatory disease (PID) diagnosis is often challenging as well as its treatment. This study sought to characterize the diagnostic and therapeutic trend among physicians at the outpatient level, in Quito, Ecuador, where currently no nationwide screening or specific clinical guideline has been implemented on PID or its main microbiological agents. Methods A retrospective analysis of medical records with pelvic inflammatory disease diagnosis in an outpatient clinic was performed. Electronic medical records from 2013 to 2018 with any pelvic inflammatory disease-related diagnoses were retrieved. Information with regard to age, sexually related risk factors, symptoms and physical exam findings, ancillary tests, method of diagnosis, and antibiotic regimens was extracted. Results A total of 186 records were included. The most frequent clinical manifestations were vaginal discharge (47%) and pelvic pain (39%). In the physical examination, leucorrhea was the most frequent finding (47%), followed by lower abdominal tenderness (35%) and cervical motion tenderness in 51 patients (27%). A clinical diagnosis was established in 60% of patients, while 37% had a transvaginal sonography-guided diagnosis. Antibiotic treatment was prescribed with standard regimens in 3% of cases, while other regimens were used in 93% of patients. Additionally, an average of 1.9 drugs were prescribed per patient, with a range from 1 to 5, all in different combinations and dosages. Conclusions No standardized methods of diagnosis or treatment were identifiable. These findings highlight the need for standardization of the diagnosis and treatment of PID attributed to chlamydial and gonococcal infections.

Modern approaches to the choice of antimicrobial agents for pelvic inflammatory diseases: the role of innovative microbiological methods

Pelvic inflammatory diseases (PID) is comprehensive term that includes infectious-inflammatory lesions of the endometrium, fallopian tubes and ovaries. PID is one of the main causes of treatment of reproductive aged women by gynecologists, and the cause of impaired reproductive function, chronic pelvic pain syndrome and ectopic pregnancy in the absence of treatment.This article provides an overview of current clinical guidelines for diagnosis and general treatment approaches of PID. A detailed analysis of modern scientific researches dedicated to the change of the PID’s pathogens structure and the peculiarities of their clinical presentation today. This analysis showed that despite the leading role of sexually transmitted infections, opportunistic flora is of great importance in the pathogenesis of this pathology. Features of the PID’s clinical course include an increase in the recurrence frequency. These features are associated with the growing worldwide phenomenon of antibiotic resistance.Data from the European Antimicrobial Resistance Surveillance Network report at the European Center for Disease Control “Antibiotic Resistance Surveillance 2017” on the resistance prevalence of clinically relevant pathogenic bacteria to the most commonly used antimicrobials. Nonspecific bacterial pathogens of PID in the European region show a fairly high rate of antibiotic resistance. At the same time, the experience of many countries demonstrates the effectiveness of the strategy of antimicrobial stewardship strategy, one of the main principles of which is microbiological research whenever possible when prescribing antibacterial therapy. Thus regardless of whether representative of the opportunistic flora is a direct cause of a severe PID course or secondary due to previous sexually transmitted diseases, its identification and antibiotic susceptibility testing is critical for the effective treatment of PID (especially severe forms) given the prevalence of antibiotic resistance.

Pelvic inflammatory disease among users and non-users of an intrauterine device

The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) has been debated. We aimed to evaluate the differences between IUD users and non-users among women hospitalised with a diagnosis of PID. Our hypothesis was that the role of a present IUD among PID patients is minimal, if any. We performed a retrospective cohort study during 2010–2018 in a tertiary university hospital. Overall, 474 hospitalised patients were diagnosed with PID. Of these, 121 patients were IUD users. The patients without an IUD were younger and had lower gravidity and parity. Among the patients without an IUD, higher rates of prior history of PID and fever at presentation were noticed. In 23.9% (29/121) of women, the IUD was inserted less than four weeks prior to the PID diagnosis. The patients with an IUD insertion-associated PID, had lower rates of tubo-ovarian abscess (2 (6.9%) versus 24 (26.0%), OR [95% CI] 0.18 (0.04–0.84), p = .02) at presentation, as well as a shorter length of stay (LOS) (median 4 versus 5 days, p = .05). In a patient in whom the IUD was retained, hospitalisation period was shorter (median LOS 4 days versus 5 days, p = .007). PID inpatients who carry an IUD represent a specific subset of patients with a milder disease. Impact statement What is already known on this subject? The correlation between pelvic inflammatory disease (PID) and a present intrauterine device (IUD) is debateable. What the results of this study add? PID inpatients who carry an IUD represent a specific subset of patients with milder disease. What the implications are of these findings for clinical practice and/or further research? Our results show that in IUD users with PID, the practice of IUD removal as part of their PID treatment is of little benefit.

Unusual presentation of bilateral pyosalpinx mimicking an ovarian torsion: A case report

IntroductionA pyosalpinx is the acute inflammation of the Fallopian tube fills up and swells with pus, which commonly results from inadequate or delayed treatment of pelvic inflammatory disease. Herein we report a case of bilateral pyosalpinx mimicking an ovarian torsion.Presentation of caseWe reported the case of a 27-year-old female patient, who presented to the emergency department with complaints of constant, worsening lower abdominal pain for 2–3 days. Pelvic and transvaginal ultrasound examinations were performed which demonstrated a large, complex cystic structure in the right adnexa with peripheral flow on color Doppler imaging. The possibilities included ovarian torsion or hemorrhagic cyst. Intraoperative findings showed bilateral pyosalpinx and treated successfully by laparoscopic bilateral salpingostomy.ConclusionThe present case highlights the diagnostic dilemma of bilateral pyosalpinx must be taken into account in the differential diagnosis of ovarian torsion or tumor, particularly in women of reproductive age.

Клинико-патогенетическое обоснование противоспаечной терапии при аппендикулярно-генитальном синдроме у женщин репродуктивного возраста

Aim: to assess the efficacy of penicillamine for the complex prevention of pelvic peritoneal adhesions in appendicitis associated with the acute conditions of uterine appendages (appendicular-genital syndrome, AGS) based on the changes in the levels of hydroxyproline and the major clinical symptoms of pelvic inflammatory disease. Patients and Methods: 157 women of reproductive age with AGS who were urgently or routinely admitted to a gynecological or surgical hospital were examined. Comparison group women were prescribed with conventional anti-inflammatory treatment or surgery as needed. Study group women additionally received penicillamine 250 mg twice daily for a month. Pre- and post-treatment non-invasive assessment of the peritoneal adhesive process was performed by measuring the levels of protein-bound and free hydroxyproline. Treatment efficacy was evaluated after 1 month by the changes in hydroxyproline levels, major clinical symptoms, and ultrasound. Results: it was demonstrated that pelvic acute inflammatory disease results in &gt; 1.5-fold increase in the levels of protein-bound and free hydroxyproline. Penicillamine as a component of the complex treatment for pelvic inflammatory disease reduces the levels of hydroxyproline to normal ranges. The changes in the major clinical symptoms and ultrasonic findings after penicillamine therapy were more significant compared to the standard treatment. Conclusions: penicillamine as a component of the complex treatment for pelvic inflammatory disease significantly accelerates the improvement of symptoms and remission as well as the formation of peritoneal adhesions. This prevents both pelvic adhesive disease and tubal- and peritoneal-factor infertility. KEYWORDS: appendicular-genital syndrome, inflammation, hydroxyproline, penicillamine, pelvic peritoneal adhesions, prevention, adhesion formation. FOR CITATION: Simrok V.V., Popova I.A., Mel’nikova D.V. Clinical pathogenic basis for anti-adhesive treatment for appendicular-genital syndrome in women of reproductive age. Russian Journal of Woman and Child Health. 2020;3(4):228–232. DOI: 10.32364/2618-8430- 2020-3-4-228-232.

Septic shock caused by abscess formation inside cystic adenomyosis after responsive treatment of pelvic inflammatory disease

Objective: To report on septic shock in a patient with an abscess inside cystic adenomyosis after responsive treatment of pelvic inflammatory disease. Case report: A 51-year-old woman with known cystic adenomyosis was admitted to the hospital due to fever and low abdominal pain. In suspicion of pelvic inflammatory disease, intravenous antibiotics were administered. As her symptoms and sings of inflammation improved, she was discharged from the hospital after five days. However, after completing 14 days of oral antibiotics, her symptoms aggravated with decreased blood pressure. Magnetic resonance imaging indicated abscess formation inside cystic adenomyosis, and total hysterectomy was performed. Postoperatively, she fell into shock condition. Intravenous antibiotics were administered for 11 days and she was discharged from the hospital with no adverse event. Conclusion: Physicians should be aware of the possibility of septic shock caused by abscess formation inside known cystic adenomyosis.

Comparison of Antibiotics and Prebiotics in Treatment of Pelvic Inflammatory Disease

ABSTRACT Introduction Pelvic inflammatory disease (PID) refers to an infectious and inflammatory disorder of the female upper genital tract. It is common among young sexually active individuals and is a major health problem both in developed and developing countries. It is usually a polymicrobial infection; however, Chlamydia trachomatis is the commonest causative agent transmitted sexually. Pelvic inflammatory disease is diagnosed by history and clinical examination. The treatment is initially empiric. Only antibiotics are good in treatment for PID and “antibiotics with prebiotics” are a new promising treatment mode for the same. This comparative study aimed to measure efficiency and compliance of only antibiotics vs antibiotics with prebiotics in the treatment of mild, uncomplicated acute PID. Setting Multispecialty Hospital Pune. Duration: 6 months. Materials and methods A descriptive cross-sectional study was conducted in randomly selected 28 consecutive outpatients with mild uncomplicated acute PID. Comparative outcome of antibiotics and antibiotics with prebiotics in correlation with the reduction of amount, consistency, and malodor of vaginal discharge along with the reduction in fornical tenderness, compliance, and frequency of adverse drug reactions was done. Results Among 28 cases, 14 (50%) were treated with oral antibiotics and 14 (50%) with oral antibiotics with prebiotics. Comparative analysis on the reduction of amount, consistency, malodor of vaginal discharge, and reduction of fornical tenderness was significant, showing antibiotics with prebiotics more effective than antibiotics. Besides, compliance was better and there were fewer adverse drug reactions with antibiotics with prebiotics. Conclusion Antibiotics with prebiotics have better efficiency and compliance over only antibiotics in the treatment of mild, uncomplicated, acute PID. How to cite this article Kale PA, Jangale KG, Kakade A. Comparison of Antibiotics and Prebiotics in Treatment of Pelvic Inflammatory Disease. J South Asian Feder Menopause Soc 2020;8(1):24–26.

Fuke Qianjin Combined with Antibiotic Therapy for Pelvic Inflammatory Disease: A Systematic Review and Meta-Analysis.

Background Pelvic inflammatory disease (PID) without timely and proper treatment can cause long-term sequelae; meanwhile, patients will be confronted with the antimicrobial resistance and side effects. Chinese patent medicine as a supplement is used to treat PID with satisfactory clinical efficacy. This study evaluated the efficacy and safety of Fuke Qianjin (FKQJ) combined with antibiotics in the treatment of PID. Methods Eight electronic databases and other resources were searched to make a collection of the randomized controlled trials (RCTs) from 1990 to 2019. The RCTs contrasting the effect of FKQJ combined with antibiotics regimens and antibiotics alone in reproductive women with PID were included. The antibiotics regimens are all recommended by the guidelines. Two reviewers independently screened the studies, extracted the data, and assessed the methodological quality of the included studies. Then, the meta-analyses were performed by RevMan 5. 3 software if appropriate. Results Twenty-three RCTs (2527 women) were included in this review. The evidence showed that FKQJ combined with antibiotics improved the markedly effective rate compared to antibiotics alone group (RR = 1.38, 95% CI 1.27 to 1.49, I2 = 42%), shortened the improvement time of low abdominal pain (MD = −1.11, 95% CI −1.39 to −0.84, I2 = 38%), and increased the rate of lower abdominal pain improvement (RR = 1.35, 95% CI 1.19 to 1.55, I2 = 0). The implementation of adjuvant reduced the recurrent rate compared with antibiotics alone (RR = 0.27, 95% CI 0.13 to 0.56, I2 = 0%). Conclusions Based on available evidence, FKQJ combined with antibiotics therapy have certain outcomes on increasing the markedly effective rate, decreasing the recurrent rate compared with antibiotics alone group. This therapy appears to improve lower abdominal pain and curtail the relief time. Due to the low quality and the risk of bias, any high-quality evidence or longer follow-up period should be advisable and necessary in the future.

Pelvic inflammatory disease treated with homoeopathic medicine Calcarea carbonica: A case Report

Introduction: Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper genital tract characterised clinically by triad of symptoms and signs: pelvic pain, cervical motion with adnexal tenderness and fever. Conventional treatment is with broad-spectrum antibiotics. The alternative medicine, especially Homoeopathy, is the second choice of therapy as per the WHO. Case reports of PID in the medical literature are scant. We aim to report a case treated with homoeopathic constitutional medicine in a woman suffering from PID. Case Summary: A 29-year-old female presented with the symptoms of white discharge per vagina, constant dull pain in the lower abdomen, low backache, fever and lassitude for 2 weeks. Clinical findings and ultrasound of the whole abdomen suggested PID. Individualised homoeopathic medicine Calcarea carbonica was prescribed in centesimal potency which showed a positive role in the treatment of PID. Causal attribution of changes in her condition to the homoeopathic treatment was depicted by modified Naranjo criteria. Future observational studies and randomised control trials are suggested to ascertain the efficacy of homoeopathy in the cases of PID.

Systemic evaluation and Meta-analysis of efficacy and safety of Kangfu Xiaoyan Suppository in treatment of pelvic inflammatory disease

To evaluate the efficacy and safety of Kangfu Xiaoyan Suppository in the treatment of pelvic inflammatory disease. Four Chinese databases,namely CNKI,VIP,WanFang and SinoMed,and three English databases Cochrane Library,namely Medline,and ClinicalTrail.gov were systematically and comprehensively retrieved from the establishment of each database to June 2018. The quality of the included studies was evaluated by using the risk assessment tools developed by the Cochrane Collaboration,and RevMan 5. 3 software was used for Meta-analysis. A total of 675 articles were retrieved,and finally 56 studies were included. The total sample size was 6 228,the test group included 3 267 cases,and the control group included 2 961 cases. The overall quality of the included studies was generally low. According to the intervention measures and outcome indicators,the included studies were divided into different subgroups for analysis. The main results of Meta-analysis showed that the recurrence rate of Kangfu Xiaoyan Suppository combined with antibiotics was lower than that of antibiotics alone. Kangfu Xiaoyan Suppository combined with antibiotics was superior to antibiotics alone in terms of abdominal pain,leucorrhea abnormality relief time,mass absorption time and pain relief time. In terms of safety,Kangfu Xiaoyan Suppository combined with antibiotics had a lower incidence of adverse reactions than antibiotics alone. Based on the results of this study,it is indicated that Kangfu Xiaoyan Suppository had a certain effect on the treatment of pelvic inflammatory disease,especially with a lower recurrence rate. The long-term effect is remarkable. No serious adverse reaction was observed. Restricted by the quality of the studies included,the above conclusion need to be further verified in high-quality,largesize,multi-center clinical researches.

Mechanisms of Fuke Qianjin Capsules in treatment of pelvic inflammatory disease based on GC-MS metabolomics

Pelvic inflammatory disease( PID) rat model was induced by the mixture of Escherichia coli,Staphylococcus aureus,and Streptococcus hemolytic-β． Gas chromatography-mass spectrometry( GC-MS) based metabolic profiling method was combined with multivariate statistical analysis,such as PCA,PLS-DA and OPLS-DA to analyze endogenous small molecule metabolites in serum of rats after treatment of Fuke Qianjin Capsules. The results showed that Fuke Qianjin Capsules could significantly improve the inflammatory pathological characteristics and tissue damages in model rats. Based on the principle of VIP>1 and P<0. 05,a total of 6 different metabolic biomarkers were identified,including L-valine,L-isoleucine,L-threonine,butanedioic acid,serine and D-glucose,respectively.The contents of these six different metabolites were significantly reversed after administration. Further analysis of the metabolite pathways through KEGG database showed that Fuke Qianjin Capsules achieved the effect possibly through glycine,serine and threonine metabolism,aminoacyl-tRNA biosynthesis and valine,leucine and isoleucine biosynthesis. Therefore,this study came to the conclusion that Fuke Qianjin Capsules can be used in the treatment of mixed bacteria induced pelvic inflammatory disease possibly by regulating amino acid and its derivative metabolism.

Treatment Practices of Pelvic Inflammatory Disease at Selected STD Clinics: STD Surveillance Network, 2015–2017 [16R

INTRODUCTION: CDC recommends broad-spectrum antimicrobial therapy (ceftriaxone 250 mg and doxycycline 100 mg BID for 14 days) for women with mild to moderate acute pelvic inflammatory disease (PID). The addition of metronidazole, commonly used to treat bacterial vaginosis (BV) and trichomoniasis, can be considered. We assessed PID treatment practices in STD clinic settings. METHODS: We conducted a cross-sectional analysis of women diagnosed with PID from 2015-2017 in 26 U.S. STD clinics. For each PID episode, we reviewed treatment information within 14 days of the visit where PID was diagnosed, stratified by concomitant diagnosis of BV and/or trichomoniasis. RESULTS: A total of 1,032 PID episodes were identified over 3 years. Treatment was documented in 941 (91.2%) episodes. Of these 941 episodes, concomitant BV and/or trichomoniasis was identified in 40.0% (377/941) of episodes (31.9% BV only, 5.2% trichomoniasis only, and 3.0% both BV and trichomoniasis). CDC recommended therapy was documented for 66.7% of all PID episodes; an additional 25.7% received ceftriaxone with dosing for doxycycline <14 days. Metronidazole, in combination with PID treatment, was documented in 52.5% of episodes. Metronidazole was more frequently included in episodes associated with BV and/or trichomoniasis (72% [271/377]) compared to those without these diagnoses (39% [220/564]). CONCLUSION: Over 90% of patients diagnosed with PID in selected STD clinics were treated with the recommended ceftriaxone; however, over a quarter did not receive the recommended dose of doxycycline. Metronidazole was provided in about half of PID episodes and was more likely to be included with concurrent BV and/or trichomoniasis.

A comparative study of moxifloxacin versus combination of doxycycline and metronidazole for treatment of uncomplicated pelvic inflammatory disease

Background: Pelvic inflammatory disease (PID), a common condition among women of reproductive age caused by various aerobic and anaerobic organisms, may sometimes lead to complications like infertility, ectopic pregnancy and chronic pelvic pain. Moxifloxacin is a broad spectrum bactericidal antibiotic acting against many gram positive, gram negative aerobic organisms and anaerobes. Rapid absorption and high bioavailability allow single daily dosing and improves compliance. The present study was done to compare the clinical and microbiological outcomes in PID patients treated with conventional doxycycline- metronidazole and moxifloxacin therapy.Methods: Women with uncomplicated PID, randomized into two groups either received 400 mg single dose of moxifloxacin daily for 14 days (group A) or doxycycline 100 mg + metronidazole 500 mg twice daily for 14 days (group B). Temperature, TLC count, ESR, CRP, microbiological assessment, Visual analogue score for pain, vaginal discharge, dyspareunia and backache were noted. The bacteriological cure was assessed by high vaginal swab for organism identification by gram stain, 10% KOH and blood sample by ELISA.Results: Total 60 women were enrolled and randomized into two groups. There was significant reduction of CRP and improved TLC in the moxifloxacin treated group. Visual analogue scores for pain, vaginal discharge and malaise were significantly reduced in the group treated with moxifloxacin. Nausea, vomiting, metallic taste, dyspepsia and diarrhoea were complained by a significant number of patients of doxycycline + metronidazole group, in contrast to the patients receiving moxifloxacin.Conclusions: Moxifloxacin 400 mg once daily, is effective and safe for treatment of PID.

The compatibility of six alkaloids in ermiao pill explored by a comparative pharmacokinetic and network pharmacological study.

Ermiao Pill (EMW), a traditional Chines medicine (TCM), composed of a two-herb pair, Phellodendri Cortex (PC) and Atractylodis Rhizome (AR), is used for the treatment of pelvic inflammatory disease and inflammatory-related diseases. However, the underlying mechanism is still unknown. Compatibility plays a crucial role in the complex drugs such as those used in traditional Chinese medicine. We propose a compositive strategy, which integrated pharmacokinetics and network pharmacology to explore the compatibility in EMW. Firstly, a simple, rapid, and selective method based on UPLC-MS/MS was established and validated for simultaneous qualification of six alkaloids in rat plasma, which was used for a comparative pharmacokinetic study of EMW and its constituent herb PC. The concentration-time profiles suggested that AR might reduce the toxicity of some alkaloids in EMW. Secondly, network pharmacology analysis showed that the key protein PTGS2 was targeted by four alkaloids, and that the competition among them might be allevited by AR. Thirdly, molecular docking exhibited interactions between the alkaloids and PTGS2 through H and π-π bonds, and the same residue formed interactions with different alkaloids, which account for the toxicity of these alkaloids, and these were confirmed by the cell viability assay. The combination of pharmacokinetics and network pharmacology clarified the compatibility in EMW.

Susceptibility of endometrial isolates recovered from women with clinical pelvic inflammatory disease or histological endometritis to antimicrobial agents

The CDC recommended outpatient treatment of pelvic inflammatory disease (PID) is an intramuscular dose of ceftriaxone plus 14 days of doxycycline, with or without metronidazole. European guidelines (2017) include moxifloxacin plus ceftriaxone as a first line regimen, particularly for women with Mycoplasma genitalium-associated PID. However, the susceptibility of bacteria recovered from the endometrium of women with PID to moxifloxacin is unknown. The in vitro antibiotic susceptibility of facultative and anaerobic bacteria recovered from endometrial biopsy samples were evaluated from 105 women having symptomatic PID and/or histologically confirmed endometritis. A total of 342 endometrial isolates from enrollment visits were identified using a combination of biochemical tests and sequencing. Isolates were tested for antimicrobial susceptibility using agar dilution against ceftriaxone, clindamycin, doxycycline, metronidazole and moxifloxacin according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Neisseria gonorrhoeae was susceptible to ceftriaxone with all isolates having an MIC of 0.03 μg/mL. All the other endometrial isolates were susceptible to ceftriaxone, except for Prevotella species, only half of which were susceptible. The in vitro susceptibility profile for BV-associated bacteria (Gardnerella vaginalis, Atopobium vaginae, Prevotella species, Porphyromonas species and anaerobic gram-positive cocci) revealed greater susceptibility to moxifloxacin compared to doxycycline. Moxifloxacin was superior to metronidazole for G. vaginalis and A. vaginae, and either metronidazole or moxifloxacin was needed to cover Prevotella species. Based on in vitro susceptibility testing, the combination of ceftriaxone plus moxifloxacin provides similar coverage of facultative and anaerobic pathogens compared to the combination of ceftriaxone, metronidazole and doxycycline. Head to head clinical studies of these treatment regimens are needed to evaluate clinical efficacy and eradication of endometrial pathogens following treatment.

Clinical Features and Therapeutic Response in Women Meeting Criteria for Presumptive Treatment for Pelvic Inflammatory Disease Associated With Mycoplasma genitalium.

There are limited published data describing clinical features and therapeutic response in women meeting the criteria for presumptive treatment of pelvic inflammatory disease associated with Mycoplasma genitalium (MG-PID). The MG-PID has been reported to respond poorly to standard PID treatment regimens and while moxifloxacin is recommended in several treatment guidelines, published data to support its use are scant. We conducted a retrospective study of women at Melbourne Sexual Health Centre between 2006 and 2017, who met the Centers for Disease Control and Prevention criteria for presumptive treatment of PID, and had MG detected as the sole pathogen. Clinical and laboratory characteristics of MG-PID were compared to cases of chlamydial PID (CT-PID) by multivariable analysis. Microbiological and clinical cure following moxifloxacin and standard PID treatment was determined for women with MG-PID who returned for test of cure between 14 and 120 days. Ninety-two patients with MG-PID were compared with 92 women with CT-PID. The MG-PID was associated with increased lower abdominal tenderness (adjusted odds ratio, 2.29; 95% confidence interval [CI], 1.14-4.60), but a lesser vaginal polymorphonuclear response compared to CT-PID by multivariable analysis. Of the 92 women with MG-PID, 54/92 (59%) received moxifloxacin (10-14 days) and 37/54 had a test of cure between 14 and 120 days; 27/37 (73%) cases had a median of 7 days of a standard regimen containing doxycycline and metronidazole +/- azithromycin before moxifloxacin. Microbial cure following moxifloxacin was 95% (95% CI, 82-99%) and did not differ from standard therapy (P = 0.948), however clinical cure was significantly higher following moxifloxacin (89%; 95% CI, 75-97%; P = 0.004)] although adverse effects were more common. Women meeting Centers for Disease Control and Prevention criteria for presumptive treatment of MG-PID did not significantly differ to those with CT-PID. Moxifloxacin was associated with higher rates of symptom resolution in women with PID, and although microbial cure was high, it did not differ between regimens.

Working together to improve the evidence base: abridged Cochrane reviews in SexuallyTransmittedInfections

The systematic review by Savaris and colleagues1 is important for two reasons. First is the review of the treatment of pelvic inflammatory disease (PID), a common condition for which the...

258. Frequency of Prescription Filling Among Adolescents Prescribed Treatment For STIs In The Emergency Department

Adolescents are frequently diagnosed with sexually transmitted infections (STI) in the emergency department (ED). Untreated, STIs can lead to serious morbidity such as pelvic inflammatory disease (PID) and infertility. Although many patients are presumptively treated in the ED with single dose antibiotics, many are prescribed outpatient treatment. However, rates of prescription filling after discharge are unknown. This study sought to determine the frequency of filled prescriptions for adolescents prescribed antibiotics for outpatient management of STIs and identify factors associated with prescription filling. We performed a retrospective medical record review of all 2016-2017 pediatric ED visits made by adolescents aged 13-19 years who were prescribed antibiotics for the treatment of Chlamydia trachomatis (CT) cervicitis/urethritis or PID in Washington DC. We extracted data on outpatient prescription filling, patient demographics, and visit characteristics. We calculated the proportion of outpatient prescriptions filled, and performed multivariable logistic regression to identify patient- and visit-level factors associated with prescription filling. During the study period, there were 695 ED visits with diagnosed STIs, resulting in 207 outpatient prescriptions for CT urethritis/cervicitis (n=64) or PID (n=143) treatment. The mean age of the study sample was 17.1 (+/- SD 1.4) years, and the majority was female (92.8%), of non-Hispanic black race/ethnicity (84.1%), and publicly insured (81.6%). Nearly 18% of patients were admitted for inpatient management of PID. The overall prescription fill rate was 58.0% (95% CI 51.2, 64.8) [CT urethritis/cervicitis (46.9%; 95% CI 34.4, 59.3) and PID (62.9%; 95% CI 54.9, 70.9)]. After adjusting for age, race/ethnicity, and insurance status, prescription filling was associated with hospital admission (aOR 2.5; 95% CI 1.1, 5.7) compared to ED discharge and PID diagnosis compared to CT cervicitis/urethritis (aOR 2.0, 95% 1.1, 3.9). Overall, adolescents evaluated in two pediatric EDs had low rates of filling outpatient prescriptions for treatment of STIs, placing them at risk for increased morbidity and complications from untreated STIs, as well as further transmission of infection. Patients who were diagnosed with PID and those who were admitted to the hospital were more likely to fill their prescriptions. Future studies should focus on understanding barriers to prescription filling to inform interventions for improvement in treatment adherence.