Amoxicillin and ibuprofen

However, although all patients with

anaerobic

Because the lack of anaerobic coverage with ofloxacin is a concern, emphasized by the high rate of treatment failure among patients with nongonococcal, nonchlamydial PID [ 16], the Centers for Disease Control and Prevention suggests the optional addition of metronidazole [ 13]. Alternatively, a randomized clinical trial of 131 women with laparoscopically confirmed PID investigated the regimen of another fluoroquinolone, ciprofloxacin, plus clindamycin [ 17]. In this study, clindamycin-ciprofloxacin was found to be as effective as ceftriaxone plus doxycycline for the clinical cure of PID (97% vs. trachomatis eradication (100% in both groups) [ 17].

gonorrhoeae was less prevalent; it was found in only 2 women who were treated with clindamycin plus ciprofloxacin, and 1 of these women achieved microbiological cure (a cure rate of 50%).

Although aerobic and anaerobic isolates were frequently identified before treatment, no comparisons of microbiological cure for these pathogens were presented. In the most recent fluoroquinolone randomized clinical trial by Ross et al.

[ 18], moxifloxacin was found to have high rates of clinical resolution (90%) and microbiological cure.

genitalium, Escherichia coli , and other gram-negative anaerobes.

trachomatis was lower amoxicillin in stores (89%), it was slightly higher than that of the comparator regimen (86%) [ 18].

gonorrhoeae was much higher (100%, compared with 82%) and the rate of drug-related adverse events was lower (23%, compared with 31%) among women treated with moxifloxacin. Also of interest because of its association with enhanced compliance, single-dose or short-duration azithromycin in the treatment of PID has been examined in a handful of studies.

Not surprisingly, compliance with single-dose azithromycin therapy has been reported to be 100% [ 25]. In a randomized clinical trial from

India

In 1 trial, 500 mg of azithromycin was administered intravenously on day 1, followed by 250 mg of oral azithromycin for 6 days. In the other trial, the intravenous protocol was conducted

for

The comparator regimens in each trial differed as well. Therefore, the optimal azithromycin regimen cannot be determined.

Furthermore, the dropout rate at the final follow-up visit was extremely high (78%), and this reduces the validity and generalizability of the microbiological cure evaluation.

A few studies have further examined the outpatient combination regimen of doxycycline and metronidazole. In a randomized clinical trial of 40 patients with laparoscopically confirmed salpingitis, combined doxycycline-metronidazole will amoxicillin treat tonsillitis treatment exhibited a low clinical cure rate of 35%, with a 50% clinical improvement rate [ 21].

The low efficacy of this regimen was replicated in an observational study in the United Kingdom involving 135 women with PID, in which only 55% experienced a clinical cure 2 or 4 weeks after treatment [ 26].

The addition of ceftriaxone to this regimen resulted in a higher but still suboptimal cure rate of 72% [ 26]. Because combined doxycycline-metronidazole provides poor coverage against N. gonorrhoeae and was also associated with the lowest pooled clinical and microbiological cure rates in the meta-analysis conducted by Walker et al.

[ 14], this is not considered to be an optimal regimen for treatment of PID.

Most randomized clinical trials of monotherapy for PID have been conducted among women with mild to moderate PID who were treated as outpatients. In a study of 84 women hospitalized because of PID, meropenem, which has demonstrated in vitro activity against a broad spectrum of gram-negative and gram-positive aerobic and anaerobic bacteria, was found to be associated with high rates of clinical response and microbiological cure that were relatively similar to those found with treatment with clindamycin plus gentamicin (clinical response rate, 88% vs. However, only 37% of patients had cultures performed after treatment and were included in comparisons of microbiological cure. Further studies are needed to confirm the use of this well-tolerated [ 22] broad-spectrum inpatient monotherapy regimen for the treatment of PID. Among the recent trials of treatment for PID, regimens including ofloxacin, moxifloxacin, azithromycin, and clindamycin-ciprofloxacin all yielded high rates of clinical cure and eradication of N.

trachomatis , although microbiological cure data among women with PID due to anaerobes are limited.

This is attributable, in part, to the complexity of studying PID due to anaerobes, because the organisms may be present as commensal bacteria in the lower genital tract, and transcervical sampling of the endometrium may result in contamination of endometrial biopsy specimens by vaginal or cervical microorganisms. However, we have previously demonstrated that contamination likely does not account for the relationships between bacterial vaginosis–associated microorganisms and acute endometritis. In the PID Evaluation and Clinical Health (PEACH) study, we have shown that anaerobic gram-negative bacteria are associated with acute endometritis independent of bacterial vaginosis [ 9].

Furthermore, anaerobic gram-negative rods and anaerobic gram-positive cocci—but not other organisms frequent among women with bacterial vaginosis (e.g., Gardnerella vaginalis and M. hominis )—are associated with acute endometritis cap amoxicillin 500mg [ 9].

Another barrier to the study of microbiological cure of PID is the lack of 100% correlation between the microbiological makeup of the endometrium and fallopian tube and the unlikelihood of determining the microbiological flora of the fallopian tube after treatment.