This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Outline oral/IM regimens for treating PID
2. Name the reasons to hospitalize for parental IV antibiotics
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from Dec 31 2017 through Dec 31 2021, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Designated for 0.1 contact hours of pharmacotherapy credit for Advance Practice Registered Nurses.
Pelvic Inflammatory Disease (PID) includes any inflammatory disorder of the female genital tract, including endometritis, salpingitis, tubo-ovarian abscess, or pelvic peritonitis. Historically, it was thought that sexually transmitted organisms, especially N. gonorrhoeae and C. trachomatis, were implicated in up to 50% of clinical cases diagnosed however recent reports show that the proportion of PID cases attributable to a specific organism is decreasing. More often, bacterial vaginosis (BV) and microorganisms that comprise the vaginal flora, such as G. vaginalis, H. influenzae, enteric gram-negative rods, and Streptococcus agalactiae, have been associated with symptoms
There should be a low threshold to treat. Recommendations include that presumptive treatment for PID should be initiated for sexually active women if they are experiencing pelvic or lower abdominal pain or if no cause for the illness other than PID can be identified. If one or more of the following three minimum clinical criteria are present on pelvic examination, such as (1) cervical motion tenderness (2) uterine tenderness, or (3) adnexal tenderness then treatment is indicated
Note: Patients weighing >150 kg with documented gonococcal infection, treatment with 1 gram of ceftriaxone should be administered, not 500mg
Cephalosporin Allergy: If community prevalence and individual risk for gonorrhea are low, and follow-up is likely
Note: If a culture for gonorrhea is positive, treatment should be based on results of antimicrobial susceptibility testing | If isolate is quinolone-resistant N. gonorrhoeae or antimicrobial susceptibility cannot be assessed (e.g., if only NAAT testing is available), consultation with an infectious disease specialist is recommended
Note: Doxycycline should be administered orally when possible due to pain with IV infusion and similar bioavailability both PO and IV. Similarly, metronidazole has similar IV and PO bioavailability and can be considered PO for women without severe illness or tubo-ovarian abscess
Timely treatment of suspected PID is warranted. Failure to clinically improve in 72 hours should prompt reconfirmation of the diagnosis and admission for intravenous antibiotic therapy. Transition to oral therapy can usually be accomplished within 24-48 hours of clinical improvement. Women should complete a total of 14 day regimen of antibiotics. They should be advised to abstain from sexual intercourse until symptoms have resolved, therapy has been completed, and partners have been treated, if needed. If tests for gonorrhea or chlamydia are positive, women should be retested 3 months after treatment
PID Diagnosis with IUD present
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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