A 25-year-old presents with fever, lower abdominal pain, and cervical motion tenderness. Transvaginal ultrasound reveals a complex adnexal mass with thick walls and internal echoes (no free peritoneal fluid). She is haemodynamically stable. According to current CDC/RCOG guidelines, what is the initial management?
- A IV cefoxitin + doxycycline; transition to oral doxycycline + metronidazole when improved ✓
- B Immediate laparoscopic surgical drainage of the tubo-ovarian abscess
- C Single-dose ceftriaxone IM + doxycycline + metronidazole orally for 14 days
- D Ultrasound-guided aspiration of the abscess followed by oral antibiotics
Explanation
A tubo-ovarian abscess (TOA) in a haemodynamically stable patient is managed with inpatient IV antibiotics: the standard CDC regimen A is IV cefoxitin (2g q6h) or cefotetan + IV/oral doxycycline, transitioning to oral doxycycline + metronidazole after clinical improvement (usually 24–48 hours) to complete 14 days total. Clindamycin + gentamicin (Regimen B) is the alternative. Single-dose ceftriaxone regimen is for uncomplicated PID without abscess. Surgical drainage is reserved for failure of 48–72 hours of IV antibiotics, ruptured TOA, or uncertain diagnosis. Haemodynamic instability requires immediate surgery.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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