提供有关盆腔炎(PID)治疗的最新指南。
Cochrane数据库的初始搜索,PubMed,使用与PID相关的关键词进行Embase,以识别1990年1月至2012年1月期间发布的任何语言的报告,并在2018年更新.包括所有以法语和英语出版的与重点领域相关的报告。基于现有数据质量的证据水平适用于每个重点领域,并用于指南。
当自发性盆腔疼痛与诱发的附件或子宫疼痛(B级)相关时,必须怀疑PID。盆腔超声检查是必要的,以排除输卵管卵巢脓肿(TOA)(C级)。微生物学诊断需要进行子宫颈和TOA采样以进行分子和细菌学分析(B级)。不复杂PID的一线治疗结合头孢曲松1g,曾经,通过肌肉内(IM)或静脉内(IV)途径,多西环素100mg×2/d,甲硝唑500mg×2/d口服(PO)10天(A级)。复杂PID的一线治疗结合头孢曲松1至2g/d,直至临床改善,多西环素100mg×2/d,IV或PO,甲硝唑500mg×3/d,IV或PO14天(B级)。如果收集量超过3cm(B级),则显示TOA的排水。患有性传播感染(STI)(C级)的妇女需要进行随访。建议使用避孕套(B级)。建议在PID(C级)后3至6个月进行阴道采样以进行微生物诊断,在插入子宫内装置(B级)之前,在选择性终止妊娠或子宫输卵管造影之前。在这些情况下,针对已鉴定细菌的靶向抗生素比系统的抗生素预防更好。
目前的PID管理需要易于重复的研究和适应STI和阴道微生物群的抗生素。
To provide up-to-date
guidelines on management of pelvic inflammatory disease (PID).
An initial search of the Cochrane database, PubMed, and Embase was performed using keywords related to PID to identify reports in any language published between January 1990 and January 2012, with an update in 2018. All identified reports published in French and English relevant to the areas of focus were included. A level of evidence based on the quality of the data available was applied for each area of focus and used for the
guidelines.
PID must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to exclude tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1g, once, by intra-muscular (IM) or intra-venous (IV) route, doxycycline 100mg×2/d, and metronidazole 500mg×2/d oral (PO) for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1 to 2g/d until clinical improvement, doxycycline 100mg×2/d, IV or PO, and metronidazole 500mg×3/d, IV or PO for 14days (grade B). Drainage of TOA is indicated if the collection measures more than 3cm (grade B). Follow-up is required in women with sexually transmitted infections (STI) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3 to 6months after PID (grade C), before the insertion of an intra-uterine device (grade B), before elective termination of pregnancy or hysterosalpingography. Targeted antibiotics on identified bacteria are better than systematic antibioprophylaxis in those conditions.
Current management of PID requires easily reproducible investigations and antibiotics adapted to STI and vaginal microbiota.