Obstetrics & gynecology science

Korean Society of Obstetrics and Gynecology (대한산부인과학회)
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Update on the management of pelvic inflammatory disease

골반염 치료의 최신 지견

  • Cho, Moon-Kyoung (Department of Obstetrics and Gynecology, Chonnam National University Medical School)
  • 조문경 (전남대학교 의과대학 산부인과학교실)
  • Received : 2010.06.17
  • Accepted : 2010.07.26
  • Published : 2010.11.15
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Abstract

Pelvic inflammatory disease (PID), the infection and inflammation of a woman's upper genital tract, is a frequent cause of infertility, ectopic pregnancy, and chronic pelvic pain among women of childbearing age. The management of PID has been largely based on the protocols issued by national or international institution. These guidelines recommended a broad-spectrum antibiotherapy in which quinolones continue to hold a key place. Yet, several significant facts such as the increase of quinolone-resistant gonococci and the emergence of 'new' pathogens have recently led us to reconsider the paradigms of the management of PID. This article reviewed lately published literatures on new bacteriological finding and recent antibiotics trials to delinate optimal regimen in managing PID.

골반염은 미생물 감염에 의해 자궁경부내구 상부의 생식기에 염증이 발생한 질환으로 난임, 자궁외 임신, 만성 골반통 등의 후유증을 남길 수 있어 골반염의 치료 시 적절한 항생제의 선택은 매우 중요하다. 여러 국가나 국제단체에서 골반염 치료를 위한 여러 권고안을 제시해 왔고, 대부분의 권고안에서 quinolone을 주 치료 항생제로 선택하고 있다. 그러나 최근 quinolone에 저항성을 보이는 임균(N. gonorrhea)이 증가하고 있으며 골반염의 원인으로 새로운 세균들이 출현하고 있으므로 현재 사용되고 있는 골반염 치료 권고안에 대한 재고가 필요하다. 따라서 본 종설에서는 골반염에 대한 최근의 문헌을 고찰하여 최근 골반염 원인균의 변화와 치료 항생제 효과에 대한 연구결과들을 살펴보고 어떤 항생제를 선택하는 것이 효과적인지에 대해 알아보았다.

Keywords

References

  1. Workowski KA, Berman SM. Sexually transmitted diseases treatment guidelines, 2006. MMWR Recomm Rep 2006; 55: 1-94.
  2. Ross J, Judlin P, Nilas L. European guideline for the management of pelvic inflammatory disease. Int J STD AIDS 2007; 18: 662-6. https://doi.org/10.1258/095646207782193911
  3. Royal College of Obstetricians and Gynaecologists. Management of acute pelvic inflammatory disease. Green-top Guideline No. 32, Nov 2008. [Internet]. London (UK): Royal College of Obstetricians and Gynaecologists, c2010 [cited 2008 Nov]. Available from: URL: http://www.rcog.org.uk/search/node/green-top+guideline.
  4. Boukes FS, Dekker JH, Wiersma TJ, Goudswaard AN. Summary of the practice guideline 'Pelvic inflammatory disease' (first revision) from the Dutch College of General Practitioners. Ned Tijdschr Geneeskd 2007; 151: 753-6.
  5. Public Health Agency of Canada. Canadian guidelines on sexually transmitted infections. [Internet]. Ottawa (Canada): Public Health Agency of Canada, 2010 [cited 2010 Jan]. Available from: URL: http://www.phac-aspc.gc.ca/std-mts/sti-its/indexeng.php.
  6. Sorbye IK, Jerve F, Staff AC. Reduction in hospitalized women with pelvic inflammatory disease in Oslo over the past decade. Acta Obstet Gynecol Scand 2005; 84: 290-6. https://doi.org/10.1111/j.0001-6349.2005.00509.x
  7. Simms I, Eastick K, Mallinson H, Thomas K, Gokhale R, Hay P, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol 2003; 56: 616-8. https://doi.org/10.1136/jcp.56.8.616
  8. Ness RB, Soper DE, Holley RL, Peipert J, Randall H, Sweet RL, et al. 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. Am J Obstet Gynecol 2002; 186: 929-37. https://doi.org/10.1067/mob.2002.121625
  9. Tapsall JW, Shultz TR, Lovett R, Munro R. Failure of 500 mg ciprofloxacin therapy in male urethral gonorrhoea. Med J Aust 1992; 156: 143.
  10. Gallay A, Bouyssou-Michel A, Lassau F, Basselier B, Sednaoui P. Neisseria gonorrhoeae infections in France in 2006: significant progression in women and persistent increase of ciprofloxacin resistance. Bull Epidemiol Hebdomadaire 2008; 5-6: 33-6.
  11. Update to CDC's sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep 2007; 56: 332-6.
  12. Lee K, Chong Y, Erdenechemeg L, Soon Song K, Hun Shin K. Incidence, epidemiology and evolution of reduced susceptibility to ciprofloxacin in Neisseria gonorrhoeae in Korea. Clin Microbiol Infect 1998; 4: 627-33. https://doi.org/10.1111/j.1469-0691.1998.tb00345.x
  13. Yoo J, Yoo C, Cho Y, Park H, Oh HB, Seong WK. Antimicrobial resistance patterns (1999-2002) and characterization of ciprofloxacin-resistant Neisseria gonorrhoeae in Korea. Sex Transm Dis 2004; 31: 305-10. https://doi.org/10.1097/01.OLQ.0000123650.98303.EB
  14. Ness RB, Kip KE, Hillier SL, Soper DE, Stamm CA, Sweet RL, et al. A cluster analysis of bacterial vaginosis-associated microflora and pelvic inflammatory disease. Am J Epidemiol 2005; 162: 585-90. https://doi.org/10.1093/aje/kwi243
  15. Livengood CH. Bacterial vaginosis: an overview for 2009. Rev Obstet Gynecol 2009; 2: 28-37.
  16. Fredricks DN, Fiedler TL, Marrazzo JM. Molecular identification of bacteria associated with bacterial vaginosis. N Engl J Med 2005; 353: 1899-911. https://doi.org/10.1056/NEJMoa043802
  17. Haggerty CL, Totten PA, Ferris M, Martin DH, Hoferka S, Astete SG, et al. Clinical characteristics of bacterial vaginosis among women testing positive for fastidious bacteria. Sex Transm Infect 2009; 85: 242-8. https://doi.org/10.1136/sti.2008.032821
  18. Hebb JK, Cohen CR, Astete SG, Bukusi EA, Totten PA. Detection of novel organisms associated with salpingitis, by use of 16S rDNA polymerase chain reaction. J Infect Dis 2004; 190: 2109-20. https://doi.org/10.1086/425929
  19. Haggerty CL, Totten PA, Astete SG, Ness RB. Mycoplasma genitalium among women with nongonococcal, nonchlamydial pelvic inflammatory disease. Infect Dis Obstet Gynecol 2006; 2006: 30184.
  20. Short VL, Totten PA, Ness RB, Astete SG, Kelsey SF, Haggerty CL. Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. Clin Infect Dis 2009; 48: 41-7. https://doi.org/10.1086/594123
  21. Haggerty CL, Totten PA, Astete SG, Lee S, Hoferka SL, Kelsey SF, et al. Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease. Sex Transm Infect 2008; 84: 338-42. https://doi.org/10.1136/sti.2008.030486
  22. Ross JD, Cronje HS, Paszkowski T, Rakoczi I, Vildaite D, Kureishi A, et al. Moxifloxacin versus ofloxacin plus metronidazole in uncomplicated pelvic inflammatory disease: results of a multicentre, double blind, randomised trial. Sex Transm Infect 2006; 82: 446-51. https://doi.org/10.1136/sti.2005.019109
  23. Rustomjee R, Kharsany AB, Connolly CA, Karim SS. A randomized controlled trial of azithromycin versus doxycycline/ciprofloxacin for the syndromic management of sexually transmitted infections in a resource-poor setting. J Antimicrob Chemother 2002; 49: 875-8. https://doi.org/10.1093/jac/dkf034
  24. Malhotra M, Sharma JB, Batra S, Arora R, Sharma S. Ciprofloxacin-tinidazole combination, fluconazole-azithromicin- secnidazole-kit and doxycycline- metronidazole combination therapy in syndromic management of pelvic inflammatory disease: a prospective randomized controlled trial. Indian J Med Sci 2003; 57: 549-55.
  25. Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res 2003; 31: 45-54. https://doi.org/10.1177/147323000303100108
  26. Savaris RF, Teixeira LM, Torres TG, Edelweiss MI, Moncada J, Schachter J. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol 2007; 110: 53-60. https://doi.org/10.1097/01.AOG.0000268801.90261.27
  27. Judlin P. Current concepts in managing pelvic inflammatory disease. Curr Opin Infect Dis 2010; 23: 83-7. https://doi.org/10.1097/QCO.0b013e328334de21