Editorials

Outpatient antibiotics for pelvic inflammatory disease

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7281.251 (Published 03 February 2001) Cite this as: BMJ 2001;322:251

Continued use of oral doxycycline and metronidazole is hard to justify

  1. Jonathan D C Ross, consultant physician in genitourinary medicine (jonathan.ross@bscht.wmids.nhs.uk)
  1. Whittall Street Clinic, Birmingham B4 6DH

    Standing at the therapeutic crossroads trying to choose a path for outpatients with pelvic inflammatory disease, a clinician may find his or her evidence based map lacking in detail. Not only is pelvic inflammatory disease hard to diagnose; once it has been diagnosed it is not clear what the best outpatient treatment is.

    Pelvic inflammatory disease remains a condition with imprecise diagnostic criteria where the clinical features are neither sensitive nor specific1 and where the “gold standard” of laparoscopy lacks standardisation and is not routinely available in clinical practice. Non-invasive diagnosis using magnetic resonance imaging has potential and may be comparable with laparoscopy and superior to transvaginal ultrasound,2 but data and access are both limited.

    Once the diagnosis of pelvic inflammatory disease has been made what outcomes are realistic after treatment? Rapid resolution of symptoms, preservation of fertility, and low rates of ectopic pregnancy are all desirable outcomes, but only the first, short term control of symptoms, has …

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