5. Conclusion
Treatment strategies for women with acute PID should be based on the polymicrobial nature of this infection. The microorganisms recovered from the upper genital tract of women with acute PID include N. gonorrhoeae, C. trachomatis, and anaerobic and aerobic bacteria common to the endogenous vaginal flora and genital mycoplasmas, especially M. genitalium. Several antibiotic regimens are available which meet these requirements. Several parenteral antimicrobial regimens have been shown to provide very good short-term clinical and microbiological efficacy; these include clindamycin plus gentamicin, cefoxitin plus doxycycline, and cefotetan plus doxycycline.
Oral therapy for acute PID is currently the most commonly used approach, in response to both economic issues and the evidence from the PEACH study demonstrating that both short-term and long-term outcomes were similar for the oral and parenteral regimens. Due to the increased quinolone resistance of N. gonorrhoeae, choices of oral regimens are more limited. Ceftriaxone or cefoxitin demonstrated excellent short-term clinical and microbiological results. The addition of oral metronidazole to this regimen is suggested by some experts including this author to provide improved anaerobic coverage and at least to treat BV which is present in up to 70% of women with acute PID.