Guidelines | Adnexitis


The guidelines recommend so-called empirical or calculated antibiotic therapy after blood cultures have been taken for pathogen detection. This means that antibiotic treatment must be started quickly (within 24-48h) without waiting for the results of the pathogen cultures. Antibiosis is therefore targeted against the bacteria expected to be present in the pathogen spectrum.

Furthermore, a change to another therapy should be possible as soon as the pathogen is known. This calculated antibiotic therapy should take the form of a 14-day infusion therapy with amoxicillin-clavulanic acid and doxycycline. Amoxicillin-clavulanic acid is directed against gram-positive and gram-negative microorganisms which are resistant to the so-called betalactamase.

However, they are sensitive to amoxicillin-clavulanic acid and can therefore be controlled by it. Doxycycline is an antibiotic from the subclass of the so-called tetracyclines and has an inhibitory effect on the growth of gram-positive, gram-negative and cell-wall-less bacteria (bacteriostatic effect). If the clinical response to infusion therapy is very good, oral administration of the antibiotics can be considered after some time and a discharge from hospital considered. After an exact pathogen analysis by blood culture, it is then possible to switch to specific antibiotics that are precisely matched to the pathogen in order to fight the pathogens even more specifically.

Differentiation between pelvic inflammation and appendicitis

The symptoms described above may also indicate appendicitis (inflammation of the appendix). It is therefore difficult to distinguish between the two diseases solely on the basis of the symptoms. Appendicitis can often occur suddenly with severe right lower abdominal pain.

Fever, nausea, vomiting and diarrhoea can also occur. Appendicitis can occur on both the right and left side. There are various examinations that can indicate appendicitis.

These include two pressure points on the stomach, McBurney and Lanz. The contralateral release pain can also occur with concomitant peritonitis with the appendicitis. With the help of ultrasound, the examining doctor may be able to detect an inflamed appendix or ovary.

However, the examination is not always possible or easy to perform. If the symptoms and the examination do not allow a distinction to be made between the two diseases, laparoscopic surgery can be performed. This is a kind of mini surgery.

Through small skin incisions, cameras can be used to look into the abdomen and, if necessary, the operation can be performed. The use of condoms has a proven protective effect. In addition, good hygiene and intimate hygiene must be ensured. Prevention with hormonal contraceptives is not uniformly ensured.