Antibiotic therapy for pelvic inflammatory disease.

Pelvic inflammatory disease (PID) is a serious illness with important medical and economic consequences, especially for young women. To make a significant impact on the acute and chronic morbidity associated with PID, experts currently recommend aggressive hospitalization and parenteral antimicrobial therapy. Antibiotic therapy, in the 1989 recommendations of the Centers for Disease Control, includes broad-spectrum cephalosporins active against penicillinase-producing Neisseria gonorrhoeae and the mixed aerobic and anaerobic genital flora, with concomitant administration of doxycycline for possible or proven infection with Chlamydia trachomatis. An alternative regimen consists of the "gold standard" combination of clindamycin plus an aminoglycoside. However, with the availability of beta-lactam/beta-lactamase-inhibitor combinations, such as ticarcillin/clavulanate and ampicillin/sulbactam, which have modest to very good activity against all these classes of bacteria, the gynecologist has the capability to utilize single-agent antibiotic regimens to adequately treat this potentially devastating sexually transmitted disease.