Pelvic Inflammatory Disease ( PID ) - Management of Infection Guidance for Primary Care

Publication: 30/09/2010  --
Last review: 11/11/2016  
Next review: 11/11/2018  
Clinical Guideline
CURRENT 
ID: 2247 
Approved By: Leeds Area Prescribing Committee 
Copyright© Leeds Teaching Hospitals NHS Trust 2016  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system. This includes a recommendation not to use them for mild or moderately severe infections unless other antibiotics cannot be used (MHRA advice November 2018).

Pelvic Inflammatory Disease (PID) in Primary Care

Symptoms include lower abdominal/pelvic pain, deep dyspareunia, abnormal vaginal bleeding or discharge, fever.
Signs include lower abdominal tenderness, adnexal tenderness and/or cervical motion tenderness on bimanual examination
Ectopic pregnancy should be excluded by performing a pregnancy test.
Severity assessment should be undertaken to determine the most appropriate agents and location for treatment
Gonorrohoea and Chlamydia are commonly implicated in PID and should be investigated for. To investigate the causes of PID send:

  • Vulvo-Vaginal Swab before speculum exam requesting Gonorrhoea and Chlamydia NAAT (and Trichomonas NAAT if risk factors)
  • Endocervical Swab requesting Gonorrhoea culture
  • pH paper test for  Bacterial Vaginosis
  • Mid Stream Specimen of Urine to exclude UTI
  • Offer HIV/HBV and Syphilis screening.

Refer to Leeds Sexual health if Partner Notification not possible and advise to abstain from sexual intercourse until all sexual contacts have completed treatment.
It is expected that the majority of patients with PID should be referred to the new Integrated Sexual Health Service for Leeds for full management including access to IM Ceftriaxone electronic Medicines Compendium information on Ceftriaxone which is available at all hubs and spokes of the new service.

Patient helpline 0113 3920334/ appointments 0113 3920333. Health adviser for clinicians 0113 3920325/20328; email referrals  shs.leeds@nhs.net   or fax 0113 3920316; extended hours M-Th 5-8pm, Sat 11-3pm call 07710027063
Outside these hours, the patients can be seen in the Acute Gynaecology Assessment Unit on Ward 24 at St James’s.  Please arrange this by contacting the Gynaecological Registrar on call via the hospital's switchboard on (0113) 243 3144

Severity of PID

First line regimen (non pregnant woman)

Second line e.g. allergy to first line

Mild- no evidence of systemic response with only mild pain (controlled with non- opiate analgesia)

IM Ceftriaxone electronic Medicines Compendium information on Ceftriaxone500 mg single dose†
PLUS
oral Doxycycline electronic Medicines Compendium information on Doxycycline* 100 mg 12-hourly for 14 days
PLUS OPTIONAL
oral Metronidazole electronic Medicines Compendium information on Metronidazole400 mg 8-hourly for 14 days
For Non-Gonorrhoea PID:
oral Ofloxacin electronic Medicines Compendium information on Ofloxacin400mg 12-hourly for 14 days
PLUS OPTIONAL
oral Metronidazole electronic Medicines Compendium information on Metronidazole400 mg 8-hourly for 14 days

IM Gentamicin 240mg single dose can be used in place of Ceftriaxone electronic Medicines Compendium information on Ceftriaxone.
*Oral Azithromycin electronic Medicines Compendium information on Azithromycin1g single dose repeated on day 7 can be used in place of Doxycycline electronic Medicines Compendium information on Doxycycline(e.g. if compliance is a concern) and can be used with oral Metronidazole electronic Medicines Compendium information on Metronidazolein patients in patients who decline IM therapy.

Moderate and Severe- evidence of systemic response
eg. Temperature, tachycardia etc.

Consider refer to Secondary Care (Acute Gynaecology Unit, St James’ Hospital via Primary Care Access Line: PCAL: (0113) 206 5996 or switchboard out-of-hours) for In-Patient Management

† IM Ceftriaxone electronic Medicines Compendium information on Ceftriaxone can be replaced with PO cefixime 400mg single dose ONLY if IM injection contra-indicated or refused by the patient as greater risk of resistance/ treatment failure.

Provenance

Record: 2247
Objective:
Clinical condition: Pelvic Inflammatory Disease
Target patient group:
Target professional group(s): Primary Care Doctors
Pharmacists
Adapted from:

Evidence base

Not supplied

Approved By

Leeds Area Prescribing Committee

Document history

LHP version 1.0

Related information

Not supplied