Department of Obstetrics and Gynecology, Medical University of South Carolina, 96 Jonathan Lucas Street, Charleston, SC 29425, USA.
Expert Rev Anti Infect Ther. 2011 Jan;9(1):61-70. doi: 10.1586/eri.10.156.
Pelvic inflammatory disease (PID) is one of the most common serious infections of nonpregnant women of reproductive age. Management of PID is directed at containment of infection. Goals of therapy include the resolution of clinical symptoms and signs, the eradication of pathogens from the genital tract and the prevention of sequelae including infertility, ectopic pregnancy and chronic pelvic pain. The choice of an antibiotic regimen used to treat PID relies upon the appreciation of the polymicrobial etiology of this ascending infection including Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and other lower genital tract endogenous anaerobic and facultative bacteria, many of which are associated with bacterial vaginosis. Currently available evidence and the CDC treatment recommendations support the use of broad-spectrum antibiotic regimens that adequately cover the above named microorganisms. The outpatient treatment of mild-to-moderate PID should include tolerated antibiotic regimens consisting of an extended-spectrum cephalosporin in conjunction with either azithromycin or doxycycline. Clinically severe PID should prompt hospitalization and imaging to rule out a tubo-ovarian abscess. Parenteral broad-spectrum antibiotic therapy with activity against a polymicrobial flora, particularly Gram-negative aerobes and anaerobes, should be implemented.
盆腔炎性疾病（PID）是育龄期非妊娠妇女最常见的严重感染性疾病之一。PID 的管理以控制感染为目标。治疗的目标包括缓解临床症状和体征，从生殖道清除病原体，并预防包括不孕、宫外孕和慢性盆腔痛在内的后遗症。用于治疗 PID 的抗生素方案的选择取决于对这种上行感染的多微生物病因的认识，包括淋病奈瑟菌、沙眼衣原体、生殖支原体和其他下生殖道内源性需氧和兼性细菌，其中许多与细菌性阴道病有关。目前的证据和疾病预防控制中心的治疗建议支持使用能够充分覆盖上述微生物的广谱抗生素方案。轻度至中度 PID 的门诊治疗应包括能耐受的抗生素方案，方案中包含一种扩展谱头孢菌素，联合使用阿奇霉素或多西环素。临床严重的 PID 应促使住院并进行影像学检查以排除输卵管卵巢脓肿。应采用针对多种微生物菌群（特别是革兰阴性需氧菌和厌氧菌）的广谱静脉抗生素治疗。
