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[Treatment of uncomplicated pelvic inflammatory disease: CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]
1Service de maladies infectieuses et tropicales, CHRU de Caen, 14000 Caen, France; Groupe de recherche sur l'adaptation microbienne (GRAM 2.0), Normandie university, UNICAEN, 14000 Caen, France.
Abstract:
This review of the treatment of uncomplicated pelvic inflammatory disease (PID) focuses on the susceptibility profile of the main microbiological causes as well as on the advantages and inconvenients of relevant antibiotics. As bacterial resistance is expanding in the community, the rules of adequate antibiotic prescribing are integrated in the treatment proposals. While the pathogenic role of anaerobic bacteria in uncomplicated PID remains discussed, the choice to provide anaerobes coverage is proposed. Thus, the antibiotic treatment has to cover Chamydia trachomatis, Neisseria gonorrhoeae, anaerobes as well as Streptococcus spp, gram negative bacteria and the ermerging Mycoplasma genitalium. On the basis of published trials and good practice antibiotic usage, the ceftriaxone-doxycycline-metronidazole combination has been selected as the first line regimen. Fluoroquinolones (moxifloxacin alone, or levofloxacin or ofloxacin combined with metronidazole) are proposed as alternatives because of their ecological impact and their side effects leading to restricted usage. When fluoroquinolone are used, ceftriaxone should be added in case of possible sexually transmitted infection. When detected, M. genitalium should be treated by moxifloxacin. Moreover, this review highlights the need to better describe the microbiological epidemiology of uncomplicated PID in France or Europe.
Insights
This review examines antibiotic treatments for uncomplicated pelvic inflammatory disease (PID), recommending ceftriaxone-doxycycline-metronidazole as a first-line regimen due to evolving bacterial resistance. It also discusses alternative fluoroquinolone options and the importance of covering specific pathogens like Chlamydia trachomatis and Mycoplasma genitalium.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Pelvic inflammatory disease (PID) treatment requires addressing multiple pathogens, including Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Streptococcus spp., gram-negative bacteria, and Mycoplasma genitalium.
- Increasing bacterial resistance necessitates careful antibiotic selection and prescribing practices for uncomplicated PID.
- The pathogenic role of anaerobic bacteria in PID is debated, yet coverage is often recommended.
Purpose of the Study:
- To review the microbiological causes of uncomplicated PID and their antibiotic susceptibility profiles.
- To evaluate the advantages and disadvantages of relevant antibiotics for PID treatment.
- To propose evidence-based antibiotic treatment strategies for uncomplicated PID, considering current resistance patterns.
Main Methods:
- Literature review of published trials and antibiotic usage guidelines.
- Analysis of microbiological data and antibiotic susceptibility profiles.
- Synthesis of evidence to formulate treatment recommendations for uncomplicated PID.
Main Results:
- The ceftriaxone-doxycycline-metronidazole combination is recommended as the first-line treatment for uncomplicated PID.
- Fluoroquinolones (moxifloxacin, levofloxacin, ofloxacin) are proposed as alternatives, with considerations for side effects and ecological impact.
- Moxifloxacin is specifically recommended for Mycoplasma genitalium infections, and ceftriaxone should be added when fluoroquinolones are used for suspected sexually transmitted infections.
Conclusions:
- Effective antibiotic treatment for uncomplicated PID must cover a spectrum of common and emerging pathogens.
- Antibiotic stewardship is crucial due to expanding community bacterial resistance.
- Further research is needed to elucidate the microbiological epidemiology of uncomplicated PID in France and Europe.
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