Pediatric emergency medicine trisk 2138 2138
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FIGURE 92.4 Transverse real-time sonogram of the pelvis of a 15-year-old patient with
gonococcal salpingitis, demonstrating a 6- × 8-cm right tuboovarian abscess (A) containing a
fluid–debris level. U, uterus; B, bladder.
Finally, the emergency physician must consider the possibility of pregnancy in
adolescents with presumed PID. Ascending genital tract infection is rare during
pregnancy. As a result, alternative diagnoses to PID, including ectopic pregnancy,
should be considered. Hospitalization is recommended for all pregnant patients
with PID.
Management
The 2015 CDC guidelines for the treatment of PID are summarized in Table 92.3
. The antibiotics listed were selected for their effectiveness in combination against
N. gonorrhoeae, C. trachomatis, and the aerobes and anaerobes responsible for
polymicrobial PID. Hospitalization is recommended for any patient with PID
whose diagnosis is uncertain, particularly if ectopic pregnancy or appendicitis
seems likely; for patients with severe clinical illness, including those with fever
or suspected pelvic abscess; and for patients who are either immunodeficient or
pregnant. Parenteral treatment is recommended for patients likely to fail a course
