Pelvic Inflammatory Disease Medication

Updated: May 03, 2019
  • Author: Kristi A Tough DeSapri, MD; Chief Editor: Nicole W Karjane, MD  more...
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Medication

Medication Summary

Treatment of pelvic inflammatory disease (PID) should include empirical broad-spectrum antibiotics to cover the full complement of common causes. Antibiotics chosen should be effective against Chlamydia trachomatis and Neisseria gonorrhoeae, as well as against gram-negative facultative organisms, anaerobes, and streptococci. The Centers for Disease Control and Prevention (CDC) has outlined antibiotic regimens for outpatient and inpatient treatment of PID.

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Macrolides

Class Summary

Macrolides are a class of antibiotics discovered in the bacterium Streptomyces. These agents are characterized by molecules made up of large-ring lactones. Many macrolides inhibit protein biosynthesis.

Azithromycin (Zithromax, Zmax)

Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected. This drug concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues.

Azithromycin is used to treat mild-to-moderate microbial infections. Plasma concentrations are very low, but tissue concentrations are much higher, giving the drug value in treating intracellular organisms. Azithromycin has a long tissue half-life. Azithromycin is related to erythromycin. It is considered by many to be treatment of choice for C trachomatis genitourinary infection because it may be administered as a single dose, which improves adherence to treatment.

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Cephalosporins, 3rd Generation

Class Summary

Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Third-generation cephalosporins are less active against gram-positive organisms then first-generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and Haemophilus influenzae.

Ceftriaxone (Rocephin)

Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Third-generation cephalosporins are less active against gram-positive organisms then first-generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and Haemophilus influenzae.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins, thereby in turn inhibiting bacterial growth. Cefotaxime is used to treat bloodstream infection and gynecologic infections caused by susceptible organisms.

Ceftizoxime (Cefizox)

Ceftizoxime is a third-generation cephalosporin with broad-spectrum gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Its gram-negative spectrum includes Moraxella catarrhalis. Dose selection depends on the severity of the infection and the susceptibility of the organism.

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Cephalosporins, 2nd Generation

Class Summary

Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid.

Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Compared with first-generation cephalosporins, second-generation agents have increased activity against gram-negative bacteria and decreased activity against gram-positive bacteria.

Cefoxitin (Mefoxin)

Cefoxitin is a second-generation cephalosporin indicated for infections with gram-positive cocci and gram-negative rods. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin.

Cefotetan (Cefotan)

Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. The dose and route of administration depend on the condition of the patient, the severity of infection, and the susceptibility of the causative organism.

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Tetracyclines

Class Summary

Tetracyclines are bacteriostatic broad-spectrum antibiotics derived from cultures of Streptomyces bacteria; they inhibit protein synthesis in susceptible organisms. These agents work by reversibly binding to the 30S ribosome of the microbial RNA and preventing the attachment of aminoacyl-tRNA with the acceptor site on the 70S ribosome.

Doxycycline (Vibramycin)

Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria.

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Antibiotics, Other

Class Summary

Lincosamide antibiotics (eg, clindamycin) inhibit protein synthesis. Imidazole antibiotics (eg, metronidazole) arrest RNA-dependent protein synthesis.

Clindamycin (Cleocin)

Clindamycin is a lincosamide used for treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest.

Metronidazole (Flagyl)

An imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa, metronidazole is used in combination with other antimicrobial agents (except for treatment of Clostridium difficile enterocolitis).

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Aminoglycosides

Class Summary

Aminoglycosides are a group of injectable bactericidal antibiotics that act by inhibiting bacterial protein synthesis. All aminoglycosides share the potential for ototoxicity and nephrotoxicity.

Gentamicin (Garamycin)

Gentamicin is an aminoglycoside antibiotic that provides gram-negative coverage. It is used in combination with an agent that is effective against gram-positive organisms and one that covers anaerobes. Dosing regimens are numerous. Adjust dose on the basis of creatinine clearance and changes in volume of distribution. Measure at least a trough level, drawn on the third or fourth dose (0.5 hours before dosing); a peak level may be drawn 0.5 hours after a 30-minute infusion.

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Penicillins, Amino

Class Summary

An acid-stable semisynthetic penicillin, ampicillin has a broader spectrum of antimicrobial action than penicillin G does. It inhibits the growth of gram-positive and gram-negative bacteria. It is not resistant to penicillinase, but when it is combined with the beta-lactamase inhibitor sulbactam, the spectrum of activity is increased.

Ampicillin-sulbactam (Unasyn)

This formulation combines ampicillin with a beta-lactamase inhibitor. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms.

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Uricosuric Agents

Class Summary

Uricosuric agents are used to increase serum concentrations of certain antibiotics and other drugs.

Probenecid

Probenecid inhibits tubular secretion of penicillin and usually increases penicillin plasma levels, regardless of the route of penicillin administration. It is used as an adjuvant to therapy with penicillin, ampicillin, methicillin, oxacillin, cloxacillin, or nafcillin. A 2- to 4-fold elevation of penicillin plasma levels is demonstrated.

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