EFFECTIVENESS
OF INPATIENT AND OUTPATIENT TREATMENT STRATEGIES FOR WOMEN WITH PELVIC
INFLAMMATORY DISEASE: RESULTS FROM THE PELVIC INFLAMMATORY DISEASE EVALUATION
AND CLINICAL HEALTH (PEACH) RANDOMIZED TRIAL.
Ness
RB, et al. Am J Obstet Gynecol 2002 May;186(5):929-37.
OBJECTIVE:
Pelvic inflammatory disease (PID) is a common and morbid intraperitoneal
infection. Although most women with pelvic inflammatory disease are treated as
outpatients, the effectiveness of this strategy remains unproven.
STUDY
DESIGN: We enrolled 831 women with clinical signs and symptoms of
mild-to-moderate pelvic inflammatory disease into a multicenter randomized
clinical trial of inpatient treatment initiated by intravenous cefoxitin and
doxycycline versus outpatient treatment that consisted of a single
intramuscular injection of cefoxitin and oral doxycycline. Long-term outcomes
were pregnancy rate, time to pregnancy, recurrence of pelvic inflammatory
disease, chronic pelvic pain, and ectopic pregnancy.
RESULTS:
Short-term clinical and microbiologic improvement were similar between women
randomized to the inpatient and outpatient groups. After a mean follow-up
period of 35 months, pregnancy rates were nearly equal (42.0% for outpatients
and 41.7% for inpatients). There were also no statistically significant
differences between outpatient and inpatient groups in the outcome of time to
pregnancy or in the proportion of women with pelvic inflammatory disease
recurrence, chronic pelvic pain, or ectopic pregnancy.
CONCLUSION:
Among women with mild-to-moderate pelvic inflammatory disease, there was no
difference in reproductive outcomes between women randomized to inpatient
treatment and those randomized to outpatient treatment.
COMMENTS:
Patients with severe PID - ie. unstable vital signs, AMS, severe pain - should
still be admitted.