Outpatient Treatment Works for Pelvic Inflammatory Disease

It's as effective as inpatient treatment and less costly, study says

WEDNESDAY, May 15, 2002 (HealthDayNews) -- Here's some rare good news for patients and the medical insurance industry alike: Women who have mild-to-moderate pelvic inflammatory disease do just as well when treated on an outpatient basis as on an inpatient basis.

In looking for key indicators of this, the authors of a study appearing in the new issue of the American Journal of Obstetrics and Gynecology found, for instance, that pregnancy rates were nearly equal for women treated as inpatients versus outpatients. The same held true for the recurrence rates of pelvic inflammatory disease (PID); chronic pelvic pain; ectopic pregnancies; and tubal obstructions. Both groups of women also took about the same amount of time to get pregnant.

The annual cost savings using outpatient treatment could be somewhere in the vicinity of $500 million annually, the researchers report.

"It's much less expensive and much less disruptive to women's lives -- it's absolutely better," says Dr. Roberta Ness, the lead author of the study and an associate professor of epidemiology, medicine and obstetrics/gynecology at the University of Pittsburgh.

Says Dr. Allan Klapper, director of gynecology and urogynecology at Beth Israel Medical Center in New York City: "It's reassuring to see that, in these patients where outpatient treatment is appropriate, the pregnancy rate appears to be identical. You have more weight behind you to treat a patient with outpatient regimen. It adds more weight to clinical practice."

PID, an infection and inflammation of all or some of the pelvic organs, affects some 1.2 million women in the United States every year. Both inpatient and outpatient treatment involve the administration of antibiotics. Even after successful treatment, however, women who have had PID are more likely to suffer from infertility, chronic pelvic pain or a recurrence of PID and ectopic disease than women who have not had the condition.

Although far more women are being treated as outpatients (up to 90 percent, say the study authors), an estimated 100,000 women are still hospitalized every year. This, despite the fact that there have not been any long-term studies to compare the two modes of treatment.

Patients being treated on an outpatient basis receive antibiotics orally. Those who are hospitalized receive the same drugs intravenously. Ness says that about half the researchers involved with the study believed that the IV antibiotics would outperform oral medications.

"There was good biologic rationale to believe that IV drugs would work better," Ness says. "Even though they are literally the same drug, the IV drugs reach higher tissue levels and they really are more active against certain bugs and certain conditions like infections deep in the pelvis, which is what we're talking about."

It's also easier to monitor compliance (whether the patient is actually taking the therapy) when the woman is confined to a hospital bed.

But after 831 women were randomly assigned to either inpatient or outpatient antibiotic treatment and the results were tallied, outpatient results equaled inpatient results, Ness says.

After 35 months, pregnancy rates between the two groups were almost identical, at about 42 percent. And there was little difference in the frequency of PID recurrence (12.4 percent for women in the outpatient group, 16.6 percent for the inpatient group), chronic pelvic pain (33.7 percent outpatient versus 29.8 percent inpatient), infertility (18.4 percent outpatient and 17.9 percent inpatient), ectopic pregnancy (1 percent outpatient and 0.3 percent inpatient) and tubal obstruction (41.7 percent outpatient versus 33.3 percent inpatient). The mean time needed to achieve pregnancy was about 21 months in both groups.

The problem is that the 42 percent pregnancy rate is so much lower than the 85 percent to 95 percent that can be expected in women who have not had PID.

"No matter what you do, the outcome is pretty bad," Klapper says. "It shows that no matter how you treat them, the damage has already been done."

What to Do: For more information on PID, check the National Institute of Allergy and Infectious Diseases, or the American Social Health Association.

SOURCES: Roberta Ness, M.D., associate professor of epidemiology, medicine and obstetrics/gynecology, University of Pittsburgh; Allan Klapper, M.D., director of gynecology and urogynecology, Beth Israel Medical Center, New York City; May 2002 American Journal of Obstetrics and Gynecology
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