LOS ANGELES — Adolescents treated for pelvic inflammatory disease are not likely to complete a 14-day course of antibiotics nor return for 72-hour evaluation, according to a study designed to see if implementation of a rigorous institutional protocol could improve care.
The protocol helped, but only somewhat, Maria Trent, M.D., said at the annual meeting of the Society for Adolescent Medicine. Previous studies have suggested that even adults have a difficult time adhering to the outpatient regimen.
The study compared management of 56 adolescent females diagnosed with pelvic inflammatory disease (PID) before implementation of the protocol with the management of 72 females seen afterward.
The protocol included disseminating a treatment algorithm and a clinical practice guideline based on Centers for Disease Control and Prevention recommendations, making available a full 14-day course of medications at discharge, providing written discharge instructions, and following up by telephone 24 hours to 2 weeks after the patients were initially seen. The patients were seen in a pediatric emergency department or a primary care clinic in urban Baltimore.
Before the intervention, 38% of patients did not receive an appropriate regimen, and only 10% returned at 72 hours to check on resolution of symptoms, as the CDC guidelines recommend, said Dr. Trent, an adolescent medicine specialist at Johns Hopkins University, Baltimore.
During the intervention, 91% of patients received an appropriate regimen. But only 43% returned for reevaluation, and an interview with 28 patients contacted after treatment found that only 61% had taken all of their doses.
Physicians should give serious consideration to inpatient treatment, she said.