Chapter 15 PID Flashcards
What are the symptoms seeing a patient who has PID?
Fever, chills, nausea vomiting, lower abdominal and pelvic pain worsen with movement and intercourse, CMT, bilateral adnexal tenderness, purulent discharge at cervical os,
What is the differential diagnosis for PID symptoms?
Appendicitis, ovarian cyst, ectopic pregnancy, septic abortion, Pyelonephritis
When should empirical treatment be given to patients with acute PID?
After a positive physical examination
What are the diagnostic testing for PID?
CBC, BMP, pregnancy test, Cervical gram stain and G and C cultures, UA, urine culture and sensitivity, Pap smear, HIV and syphilis testing
What is the appropriate inpatient regimen for PID?
IV Cefoxitin plus IV doxycycline , At the 24 hours of sustained clinical improvement discharge a patient with PO antibiotics for outpatient management. Patient should also be treated systematically for pain fever and nausea
What are the criterias for inpatient management?
Severe Abdominal pain with fever greater than 102.2 F.
Pregnancy. Inability to take PO anabiotics because of nausea vomiting, resistance or noncompliance.
Pelvic/tubo ovarian abscess.
What are the inpatient Empiric antibiotic regimen that can be given to PID patients?
IV Cefoxitin or IV cefotetan plus IV PO doxycycline
IV Clindamycin and IV gentamicin
IV Ampicillin sulbactam and IV or PO Doxycycline
PO doxycycline is preferred initially if patient able to tolerate PO intake. Switch to entirely PO antibiotics after 24 hours of sustain clinical improvement
What is the outpatient regimen for PID?
Ceftriaxone IM one dose plus doxycycline PO times 14 days.
Cefoxitin IM one dose plus probenecid PO one dose plus doxycycline for 14 days. Metronidazole may be added for bacterial vaginosis trichomonas or pelvic abscess or recent gynecologic instrumentation.
Follow up within 72 hrs. to ensure improvement
What is the counseling for this patient?
Patient counseling, contraception counseling, medication compliance, safe sex counseling, smoking cessation, treat partner
What is therapy for PID?
IV Access, IV NS, antibiotics, antiemetic (Ondansetron), analgesics , antipyretic NPO Bed rest
what is the stepwise approach for pain?
Non-opioid such as acetaminophen and NSAIDs mild-moderate pain, weak opioids such as codeine and dihydrocodeine or tramadol for moderate to severe pain and severe opioids such as oxycodone and morphine for severe pain
