Treatment Of Adnexitis - A List Of Drugs, Treatment Regimens

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-07 17:49

Treatment of adnexitis

Adnexitis, or salpingo-oophoritis, is an infectious inflammatory disease of the appendages (fallopian tubes, ovaries and ligaments). According to medical statistics, adnexitis ranks first in terms of prevalence among all pathologies of the female reproductive sphere. The acute form of the disease, in the absence of full treatment, turns into chronic adnexitis with many relapses and complications.

Content:

• Treatment of acute adnexitis
• Treatment of chronic adnexitis
• List of medicines for the treatment of adnexitis
• Treatment regimens for adnexitis
• Why are antibiotics necessary for adnexitis?
• Treatment of adnexitis in pregnant women
• Indications for surgical treatment of adnexitis

Treatment of acute adnexitis

Acute manifestations of adnexitis are treated in a gynecological hospital, while the patient observes bed rest. Treatment of inflammation of the appendages is carried out with antibiotics, pain relievers, anti-inflammatory drugs. When choosing antibacterial agents, the doctor prefers drugs with a long half-life, using drugs from different groups.

At the beginning of treatment, preference is given to the intravenous or intramuscular route of administration of antibiotics, then the oral route is practiced - therapy using tablets.

To stop the effects of intoxication of the female body with the waste products of pathogenic bacteria, the patient is administered:

• Glucose;
• Protein solutions;
• Reopolyglyukin;
• Hemodez;
• Physiological fortified solution.

To relieve pain, analgesics, suppositories with anesthetic and anti-inflammatory effects, cold on the abdomen are used. After removing the symptoms of acute inflammation, the patient is prescribed physiotherapy - electrophoresis with calcium, magnesium, copper. After 2-3 months, the achieved results are fixed by treatment in a sanatorium of the corresponding profile.

Treatment of chronic adnexitis

The treatment regimen for chronic adnexitis varies depending on the stage at which the disease is - in the stage of exacerbation or in remission.

Indications for the appointment of antibacterial drugs:

• Treatment of recurrence of adnexitis;
• Lack of antibacterial therapy in the phase of acute adnexitis;
• A high risk of exacerbation of symptoms of the disease during physiotherapy.

Additionally, analgesics are prescribed, suppositories to eliminate inflammation and pain, vitamins, drugs to prevent adhesions.

Medical procedures and measures for the treatment of chronic adnexitis:

• Physiotherapy UHF, amplipulse therapy, electrophoresis with iodine, zinc, magnesium;
• Mud therapy and treatment with sodium chloride and arsenous waters (shown with the simultaneous course of adnexitis and endometriosis, fibroids);
• Radon and iodine-bromine baths (shown when adnexitis is combined with hyperestrogenism);
• Acupuncture;
• Physiotherapy;
• Psychotherapy;
• Diet with the exception of salty, fatty and fried foods.

For the prevention of exacerbations of chronic adnexitis, it is recommended to avoid hypothermia, emotional and physical overload.

List of medicines for the treatment of adnexitis

Salpingitis, or inflammation of the fallopian tubes, is very rare as an independent disease. Most often, this pathology is combined with inflammatory diseases of the uterus and ovaries or is their consequence. In exceptional cases, purulent processes in the inflamed fallopian tubes, ovaries and uterus combine, increasing the risk of sepsis and pelvioperitonitis.

In order to prevent the transition of acute inflammation to a chronic form, the occurrence of complications such as infertility, abscess, pyosalpinx, adhesion formation, antibacterial drugs are required immediately after the diagnosis is made.

Before starting treatment for adnexitis, it is required to determine which infectious agent caused the inflammatory process. It can be anaerobic and gram-positive bacteria, chlamydia, mycoplasma, gonococcus, streptococcus. Bacterial culture of secretions taken from the cervical canal will help determine the sensitivity of the pathogen to antibiotics.

Groups of antibacterial drugs for the treatment of acute adnexitis:

• Cephalosporins - Cefotaxime, Ceftriaxone, Cefoxitin;
• Inhibitor-protected penicillins - Amoxicillin / Clavulanic acid, Ampicillin / Sulbactam;
• Tetracyclines - Doxycycline;
• Inhibitor-protected cephalosporins - Cefoperazone / Sulbactam;
• Macrolides - Erythromycin, Azithromycin, Roxithromycin, Clarithromycin, Spiramycin;
• Fluoroquinolones - Ciprofloxacin, Ofloxacin;
• Nitroimidazoles - Ornidazole, Metronidazole;
• Aminoglycosides - Gentamicin;
• Lincosamides - Clindamycin;
• Carbapenems - Meropenem, Imipenem.

Treatment regimens for adnexitis

Salpingo-oophoritis therapy is carried out according to a certain scheme. The dosage of drugs is adjusted in accordance with the age of the woman and the stage of the inflammatory process.

Options for antimicrobial treatment for adnexitis:

• A combination of Ceftriaxone (2 times a day) or Cefoxitin (1 time a day) with Doxycycline. The course of treatment with cephalosporins lasts 48 hours or more, is canceled immediately after the patient's condition improves. Doxycycline is taken for at least 2 consecutive weeks.
• If there is a suspicion of infection with a mixed pathogenic flora or with a severe form of adnexitis, Metronidazole is added to the two drugs from the previous scheme.
• Step therapy - Clindamycin IV every 8 hours in combination with Gentamycin IV or IV 3 times a day is replaced every other day by oral administration of Doxycycline (2 times a day) or Clindamycin (4 times a day) in combination with Metronidazole. The course of treatment lasts 14 days.
• Step therapy, scheme 2 - injections of inhibitor-protected penicillins (Ampicillin / Sulbactam) IV 4 times a day are replaced by oral administration of Doxycycline.
• Ceftriaxone or Cefotaxime in combination with Metronidazole.
• A combination of protected penicillins (Amoxicillin / Clavulanate or Ampicillin / Sulbactam) or protected cephalosporins (Cefoperazone / Sulbactam) with macrolide antibacterial drugs (Spiramycin, Erythromycin, Clarithromycin).
• The combination of Metronidazole + cephalosporins with drugs of the macrolide class (used for Doxycycline intolerance).
• Fluoroquinolone therapy - Metronidazole in combination with Ofloxacin or Ciprofloxacin, plus Doxycycline or a drug from the macrolide group. Used for patients over 18 years of age.
• Treatment of severe adnexitis is a combination of carbapenems (Imipenem or Meropenem) with Doxycycline or antibacterial agents from the macrolide group.
• Treatment of adnexitis caused by gonococcus - Ceftriaxone (or Cefoxitin) + Metronidazole + Doxycycline in combination with Probenecid, which increases the concentration of antibacterial drugs in the blood plasma. Cephalosporin and Probenecid are taken once, the course of treatment with Metronidazole and Doxycycline lasts 2 weeks. If there are contraindications to the use of cephalosporins with a gonococcal infectious agent, Azithromycin is prescribed.
• Therapy of tubo-ovarian abscess - Clindamycin is included in the treatment regimen.

Treatment of adnexitis with minimal symptoms is carried out with oral preparations with high bioavailability:

• Azithromycin (1000 mg) at the beginning of treatment with its replacement with Clindamycin.
• Drugs from the penicillin group (Amoxiclav, Augmentin, Flemoklav) + Doxycycline (replaced by macrolides in case of intolerance).
• Fluoroquinolones (Ciprofloxacin) + macrolides (Rovamycin, Clarithromycin) + Metronidazole.
• Ofloxacin in combination with Ornidazole.
• Fluoroquinolones (Ciprofloxacin, Ofloxacin) + Doxycycline.
• Ciprofloxacin + Doxycycline + Clindamycin.
• Treatment of adnexitis caused by chlamydia - Doxycycline, or Ofloxacin, or macrolides (Josamycin, Azithromycin).
• Treatment of adnexitis caused by gonococcus - cephalosporins or macrolides (Ceftriaxone, Cefotaxime, Azithromycin), if contraindicated, are replaced with fluoroquinolones (Ciprofloxacin).
• Treatment of adnexitis caused by mycoplasma - Doxycycline, Azithromycin, Moxifloxacin, Ofloxacin, Josamycin.

Why are antibiotics necessary for adnexitis?

More than 20% of women who have undergone adnexitis suffer from infertility in the future, they have an ectopic pregnancy 10 times more often. The consequence of the chronic form of the disease is the formation of adhesions in the pelvic organs, disrupting the blood supply, causing congestion. Pain syndrome becomes an obstacle to a full sexual life.

To avoid such complications, you should consult a doctor to prescribe a treatment regimen for adnexitis. Independent use of antibacterial agents is unacceptable, as is the use of suppositories. This form of drugs with analgesic and anti-inflammatory effects is prescribed as an adjunct to antimicrobial therapy.

Purpose of using candles:

• Elimination of pain syndrome;
• Decrease in temperature;
• Relief of inflammation;
• Prevention of adhesion formation.

The minimum course of treatment for adnexitis is 10-14 days. If an STD is suspected, a thorough examination and simultaneous treatment of the woman and her sexual partner is required.

Treatment of adnexitis in pregnant women

When treating salpingo-oophoritis during pregnancy, the following groups of drugs are excluded from the treatment regimen:

• Tetracyclines - Doxycycline;
• Aminoglycosides - Gentamicin;
• Lincosamides - Clindamycin;
• Fluoroquinolones - Ciprofloxacin, Ofloxacin.

In the first trimester of pregnancy, Metronidazole is prohibited. In the second and third trimesters, its use is possible only after a balanced decision by the attending physician. If in a pregnant woman adnexitis is provoked by chlamydia, its treatment is carried out with Erythromycin, Azithromycin, Josamycin, Spiromycin. As an alternative, Amoxicillin is prescribed.

Indications for surgical treatment of adnexitis

In what cases is the surgical treatment of adnexitis performed - urgent indications:

• Lack of effect from treatment with medicines and other methods;
• Anatomical changes in organs and tissues against the background of chronic adnexitis;
• Formation of purulent foci (tubo-ovarian abscess, pyosalpinx, ovarian abscess);
• Frequent relapses of chronic adnexitis against the background of the lack of effect from conservative treatment;
• The formation of an extensive adhesive process, accompanied by severe pain syndrome;
• The combination of chronic adnexitis with endometriosis of the ovaries and fallopian tubes;
• The combination of adnexitis with a cyst or ovarian tumor.

At the initial stage of acute adnexitis, it is possible to carry out diagnostic laparoscopy with antiseptic treatment of the abdominal cavity with solutions of antibiotics and antiseptics. The volume of surgical intervention in the late stages of the course of adnexitis depends on the presence or absence of purulent inclusions, cysts or ovarian tumors, uterine fibroids, adhesions.

You need to know that even a flawlessly performed operation to restore the patency of the fallopian tubes and eliminate adhesions does not guarantee reproductive health.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.