At 1st visit Pt. C/o severe abdominal pain @lt. Iliac fossa,2 episodes of vomiting n loose motions. Rx givenTab. Oflomac oz bd/ondem tds/pantoprazol bd/cataspa tds. Vom. N Lm controlled. Pain reduced. Then done usg. Reports r attached. Ovarion cyst n PID. Given doxy 100 bd/continued cataspa ondem n pantoprazol. What antibiotic should be used ofloxacin 400/ ceftriaxone iv/im or n e else.. For the complete relief? Still there is mild pain.plz discus the case...

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Thanks Dr. Pallavi Vinayak. It is Pleasure to share Ac. Abbdomin case... You mentioned Severe Abd. Pain Left Iliac Fossa with Vomittings & Loose motions... So clinically You First exclude Amoebiasis which can mimic any Abdminal Pain... Ultrasound Study exclude Ac. APPENDICITIS...As Patient is Young age... Expect PID only... As Pain also Reduced ANTIBIOTICS So refers to Infection only... My advice is Mixed Organismal Infection best Antibiotics are IV Ceftrioxem + IV Metrogyl... continue one course... Pain subsides... If not refer the case to Gynaecologist....
ceftrixone+sulbactum i.v. for 5-7 days.then oral cefixime+clav for 10days. Placentrex inj daily for 14 days . For ov.cyst ocp for 3-6 cycle. sporlac cap &antacid may be coprescribed with antispasmodic s.o.s.
Mam Is it necessary 2 give iv treatment..coz pt. Is from territory area..practically it is impossible for her to come n go everyday..coz here is no admission/hospitalisation facility
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anyway,,,I opine a flouroquinolone with an antibiotic with both mrsa and anaerobic coverage like clindamycin would be a better choice....if chlamydia suspected,doxycycline could be used instead
Hospitalization facilities r not available here..n its practically impossible for her 2 cum n go everyday...so I have already starred doxycycline. 100 bd...so plz suggest what should i do next?
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Gastro enteritis or UTI with PID ? Cefixime + Ornidazole BD Dyclomine + Mefenamic + Paracetamol TID . Tab Domperidone BD . Ocid 20 BD . Tab Lactobacillus BD Deworming ORS +zinc with water.
If acute abd with k/n ovarian cyst, itccan be twisting of the cyst ,see for all parameters otherwise open the and go for oophrectomy.
fluroquinolone Cx in 1st trimester also tetracyclines...acc to CDC 2015 guidelines admit patient as pregnancy with PID is indication for in patient treatment...give inj cefoxitin 2gm 12hourly or inj cefotetan 2gm iv 8 hourly till symptom subsides.. then start orally on the drug from same category.
if at all its a simple cyst,,,minimal fluid in douglas pouch may or may not point to pid.....if it was right iliac fosssa tenderness at presentation why not rule out retrocaecal subacute appendicitis?....from history it was left iliac fossa tenderness and usg findings point to right..
Actually.. Pt. Feels severe pain at left side.... Only probe tenderness to rif is present
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U told patient is having pain at lf side n Usg suggest rt sided cyst ....PID can be manage with 5 day course of oflox with ornidazole bd along with NSAIDs n antacids ....but patient is having pain with vomiting look for intestinal or urinary cause
If no fever, no Leukocytosis on CBC and no RIF pain or tenderness you can safely stop antibiotics.... If doubt about appendicitis persists then go for CECT Abdomen. If you will describe the character of pain then probably will be more helpful
It's glad 2 share that pt is good now n have no complaints since then. At 2nd consultation i have given azithro.500 hs *6days Doxy 100 1 bd*14 days Secnidazole 2gm stat Cataspa 1bd*3days n then od *3days
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