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Women with Pelvic Inflammatory Disease Treated as Outpatients Have Long-term Outcomes Comparable to Those Treated as Inpatients

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Press Release Date: May 15, 2002

Women with mild to moderate pelvic inflammatory disease (PID)—a leading cause of infertility—who are treated as outpatients have recovery and reproductive outcomes similar to those for women treated in hospitals, according to a study funded by the Agency for Healthcare Research and Quality (AHRQ).

"Treating women with PID in an outpatient setting means receiving care won't disrupt their daily lives and those of their families," said Carolyn Clancy, M.D., acting director of AHRQ. "This study provides the first evidence of the comparable effectiveness of outpatient treatment."

The PID Evaluation and Clinical Health (PEACH) study was a randomized clinical trial designed to compare the effectiveness of inpatient and outpatient treatment strategies in preserving fertility and preventing PID recurrence, chronic pelvic pain and ectopic pregnancy for women with mild to moderate PID. Women treated as outpatients received a single injection of cefoxitin and an oral dose of probenecid, followed by a 14-day supply of oral doxycycline. Those treated in a hospital were given multiple intravenous doses of cefoxitin plus doxycycline during a minimum inpatient stay of 48 hours. The women's care then was followed for 35 months to document long-term outcomes.

The short-term clinical improvements were similar for women treated in inpatient and outpatient settings. After 35 months of follow-up, pregnancy rates were nearly equal between the groups, as was the amount of time it took to become pregnant. There also were no statistically significant differences between the proportion of women with ectopic pregnancy, chronic pelvic pain or PID recurrence.

Each year, about 1.2 million women are treated for PID, a sexually transmitted disease that causes infection and inflammation of all or some of the pelvic organs. Untreated, it can cause chronic pelvic pain, ectopic pregnancy, and infertility. Over 100,000 women with PID are hospitalized each year, and about 15 percent of them have acute and serious versions of the disease that require intensive inpatient treatment. But for approximately 85,000 women with mild or moderate PID who currently are being hospitalized, treating them as outpatients may save around $500 million each year.

"Over the past decade there has been an overall shift to save money in health care by treating disease in outpatient settings rather than in a hospital," said lead author Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh. "The results of our study show that this type of shift in the treatment of PID does not cause harm to women."

Details can be found in "Effectiveness of Inpatient and Outpatient Treatment Strategies for Women with Pelvic Inflammatory Disease: Results from the PID Evaluation and Clinical Health (PEACH) Randomized Trial," by Dr. Ness and colleagues, published in the May 2002 issue of the American Journal of Obstetrics and Gynecology.

Editor's Note: For interviews with Dr. Ness, please contact Kathryn Duda at the University of Pittsburgh Medical Center News Bureau, (412) 624-2607 or dudak@msx.upmc.edu.

For additional information, please contact AHRQ Public Affairs, (301) 427-1364: Karen Carp, (301) 427-1858 (KCarp@ahrq.gov) or Karen Migdail, (301) 427-1855 (KMigdail@ahrq.gov).


 

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