Relevant issues of management of patients with inflammatory diseases of the pelvic organs
Background. Pelvic inflammatory diseases (PID) occur in 12-13 % of young women, 65-70 % of outpatients and 30 % of inpatients with gynecological diseases. The consequences of PID include infertility, chronic pelvic pain syndrome, menstrual disorders, etc. Treatment of PID is a multidisciplinary problem in the field of gynecology, urology, and venereology.
Objective. To describe the modern treatment of PID.
Materials and methods. Analysis of literature sources on this issue; own study to study the effectiveness of the PID treatment with Reosorbilact (“Yuria-Pharm”) and levofloxacin + ornidazole (Grandazole, “Yuria-Pharm”). Women of the main group were additionally prescribed fluconazole, diclofenac, vaginal baths with Dekasan (“Yuria-Pharm”). The treatment lasted 7 days. Treatment of the comparison group included ceftriaxone, metronidazole, diclofenac, doxycycline, fluconazole, chlorhexidine.
Results and discussion. Chronic PID often have a latent course. 70 % of them are caused by the specific flora (Chlamydia trachomatis, Neisseria gonorrheae, anaerobes, gram-negative bacteria). The frequency of mixed polymicrobial processes and polychemical resistance is increasing. The presence of bacterial vaginosis allows the infections to recur constantly. Pathogens that cause PID can also cause extragenital pathological conditions (perihepatitis, Reiter’s syndrome, enteritis, colitis, cholecystitis). Diagnostic criteria for PID are the following: pain in the appendages or when the cervix is displaced during the bimanual examination, fever, leukorrhea and menorrhagia. If PID is suspected, a bimanual examination should be performed to rule out acute appendicitis. Ultrasound or computed tomography should be performed to rule out tuboovarian tumors and make a differential diagnosis with intestinal or urinary tract disease. The etiological diagnosis requires microbial and molecular examination of the contents of the vagina and cervix. Fluoroquinolones with metronidazole for 14 days are the first line therapy of uncomplicated PID. Chronic inflammation has no mechanisms of self-completion and can last for years and decades. In gynecology, chronic inflammation is divided into infectious, allergic and autoimmune type. Patients with recurrence of chronic PID are characterized by mixed infections and the formation of biofilms, allergies, low efficiency of immune cells. To overcome the polychemical resistance of pathogens, it is advisable to use effective hydrodynamic drugs that can act as a hydraulic conductor of the antibacterial agent, improve microcirculation in the inflammatory focus, optimize venous hemodynamics and lymphatic drainage. Sorbitol has all these properties. In addition, sorbitol increases the tropism of fluoroquinolones to gram-positive microorganisms and has own bacteriostatic effect. In the own study, it was found that the increase in the resistance index of the ovarian arteries was associated with increased intensity of pain in the lower abdomen, pathological vaginal discharge and fever, which justifies the use of vasoactive drugs in the treatment of PID. In the Reosorbilact and Grandazole treatment groups, normalization of clinical and laboratory parameters occurred in 100 % of women, whereas in 12.1 % of control group members the result was considered insufficient, requiring antibiotic replacement and continuation of therapy.
Conclusions. 1. In women with PID, there is a connection between blood flow in the ovarian arteries and the severity of the clinical signs of PID, which justifies the use of hemodynamic drugs. 2. Improvement of intrapelvic hemodynamics on the background of Reosorbilact was the key to successful use of Grandazole. 3. Co-administration of Reosorbilact and Grandazole is a promising method of empirical therapy of PID.
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