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Long-term outcomes are comparable for inpatient and outpatient treatment of women with pelvic inflammatory disease

Women with mild to moderate pelvic inflammatory disease (PID) who are treated as outpatients have recovery and reproductive outcomes similar to those for women treated in hospitals, according to a recent study that was funded by the Agency for Healthcare Research and Quality. If left untreated, PID can result in chronic pelvic pain, infertility, and ectopic pregnancy.

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 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 followup, 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. Over 100,000 women with PID are hospitalized each year, and about 15 percent of these women 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.

According to lead author Roberta B. Ness, M.D., M.P.H., of the University of Pittsburgh, the findings from this study demonstrate that shifting treatment of mild to moderate PID from inpatient to outpatient settings will not cause harm to affected women. In addition, women who receive outpatient treatment for PID will have less disruption to their daily lives.

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, David E. Soper, M.D., Robert L. Holley, M.D., and others, in the May 2002 American Journal of Obstetrics and Gynecology 186(5), pp. 929-937.

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