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Effectiveness of Treatment Strategies of Some Women With Pelvic Inflammatory Disease

A Randomized Trial

From the ¹University of Pittsburgh, Pittsburgh, Pennsylvania; ²University of Alabama School of Medicine, Birmingham, Alabama; ³Emory University, Atlanta, Georgia; ⁴Women and Infants Hospital, Providence, Rhode Island; ⁵University of Pennsylvania, Philadelphia, Pennsylvania; ⁶MetroHealth Medical Center, Cleveland, Ohio; ⁷Wayne State University, Detroit, Michigan; ⁸Ohio State University, Columbus, Ohio; and ⁹Medical University of South Carolina, Charleston, South Carolina.

Objective: Among all women with pelvic inflammatory disease (PID), prevention of adverse reproductive consequences appears to be similarly achieved by outpatient treatment and inpatient treatment. We assessed whether outpatient is as effective as inpatient treatment in relevant age, race, and clinical subgroups of women with PID.

Methods: Women with clinical signs and symptoms of mild-to-moderate pelvic inflammatory disease (n = 831) were randomized into a multicenter trial of inpatient treatment, initially employing intravenous cefoxitin and doxycycline compared with outpatient treatment consisting of a single intramuscular injection of cefoxitin and oral doxycycline. Comparisons between treatment groups during a mean of 84 months of follow-up were made for pregnancies, live births, time to pregnancy, infertility, PID recurrence, chronic pelvic pain, and ectopic pregnancy.

Results: Outpatient treatment assignment did not adversely impact the proportion of women having one or more pregnancies, live births, or ectopic pregnancies during follow-up; time to pregnancy; infertility; PID recurrence; or chronic pelvic pain among women of various races; with or without previous PID; with or without baseline Neisseria gonorrhoeae and/or Chlamydia trachomatis infection; and with or without high temperature/white blood cell count/pelvic tenderness score. This was true even in teenagers and women without a previous live birth. Ectopic pregnancies were more common in the outpatient than the inpatient treatment group, but because these were so rare, the difference did not reach statistical significance (5 versus 1, odds ratio 4.91, 95% confidence interval 0.57–42.25).

Conclusion: Among all women and subgroups of women with mild-to-moderate PID, there were no differences in reproductive outcomes after randomization to inpatient or outpatient treatment.

Level of Evidence: I

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