Pediatric emergency medicine trisk 395

TABLE 80.3
TREATMENT OF INFECTIOUS CAUSES OF VAGINITIS AND
VAGINAL DISCHARGE


1.

Recommended regimens for the treatment of candidal
vulvovaginitis
Over-the-counter intravaginal:
Clotrimazole 1% cream 5 g intravaginally for 7–14 days
Clotrimazole 2% cream 5 g intravaginally for 3 days
Miconazole 2% cream 5 g intravaginally for 7 days
Miconazole 4% cream 5 g intravaginally for 3 days
Miconazole 100 mg vaginal suppository, one suppository for 7 days
Miconazole 200 mg vaginal suppository, one suppository for 3 days
Miconazole 1,200 mg vaginal suppository, one suppository for 1 day
Tioconazole 6.5% ointment 5 g intravaginally in a single application
Prescription intravaginal:
Butoconazole 2% cream (single-dose bioadhesive product), 5 g
intravaginally for 1 day
Terconazole 0.4% cream 5 g intravaginally for 7 days
Terconazole 0.8% cream 5 g intravaginally for 3 days
Terconazole 80 mg vaginal suppository, one suppository for 3 days
Prescription oral:
Fluconazole 150 mg oral tablet, one tablet in a single dose
2. Recommended regimens for the treatment of bacterial vaginosis
Prescription oral:
Metronidazole 500 mg orally twice a day for 7 days a
Prescription intravaginal:
Metronidazole gel 0.75%, one full applicator (5 g) intravaginally, once

a day for 5 days
Clindamycin cream 2%, one full applicator (5 g) intravaginally at
bedtime for 7 days b
3. Recommended regimens for the treatment of Trichomonas vaginalis
Metronidazole 2 g orally in a single dose
Tinidazole 2 g orally in a single dose
4. Recommended regimens for the treatment of Chlamydia
trachomatis
Azithromycin 1 g orally in a single dose


Doxycycline 100 mg orally twice a day for 7 days
5. Recommended regimens for the treatment of Neisseria gonorrhoeae
Ceftriaxone 250 mg IM in a single dose
PLUS
Azithromycin 1 g orally in a single dose
OR
Doxycycline 100 mg orally twice a day for 7 days
6. Recommended regimen for OUTPATIENT treatment of pelvic
inflammatory disease
Ceftriaxone 250 mg IM in a single dose
PLUS
Doxycycline 100 mg orally twice a day for 14 days
WITH or WITHOUT
Metronidazole 500 mg orally twice a day for 14 days
7. Recommended regimen for INPATIENT treatment of pelvic
inflammatory disease
Regimen 1:
Cefotetan 2 g IV every 12 hours
OR

Cefoxitin 2 g IV every 6 hours
PLUS
Doxycycline 100 mg orally or IV every 12 hours
ADD
Metronidazole 500 mg IV every 12 hours if TOA present
Regimen 2:
Clindamycin 900 mg IV every 8 hours
PLUS
Gentamycin loading dose IV or IM (2 mg/kg) followed by a
maintenance dose (1.5 mg/kg) every 8 hours
a Consuming
b Might

alcohol should be avoided during treatment and for 24 hours thereafter.
weaken latex condoms and diaphragms for 5 days after use.


TABLE 80.4
CRITERIA FOR ADMISSION TO THE HOSPITAL FOR PELVIC
INFLAMMATORY DISEASE
• Surgical emergency cannot be excluded
• Pregnancy
• Failed clinical improvement on appropriate PO antibiotics
• Poor compliance or inability to tolerate PO outpatient regimen
• Presence of severe illness, nausea and vomiting, or high fever
• Suspected/confirmed tubo-ovarian abscess
Suggested Readings and Key References
American Academy of Pediatrics. Policy statement: Use of chaperones
during the physical examination of the pediatric patient. Pediatrics
2011;127(5):991–993.

Amsel R, Totten PA, Spiegel CA, et al. Nonspecific vaginitis: diagnostic
criteria and microbial and epidemiologic associations. Am J Med
1983;74(1):14–22.
Bazella C, Greenfield M. Vaginal discharge and odor. In: Adams Hillard P,
ed. Practical Pediatric and Adolescent Gynecology . 1st ed. Cleveland,
OH: John Wiley & Sons Ltd; 2013:14–17.
Beyitler I, Kavukcu S. Clinical Presentation, diagnosis and treatment of
vulvovaginitis in girls: a current approach and review of the literature.
World J Pediatr 2017;13(2):101–105.
Cemek F, Odabas D, Senel U, et al. Personal hygiene and vulvovaginitis in
prepubertal children. J Pediatr Adolesc Gynecol 2016;29:223–227.
Centers for Disease Control and Prevention. Sexually Transmitted Diseases
(STDs),
2015
STD
Guidelines.
Available
at
. Accessed March 2020.
Emans SJ. Vulvovaginal problems in the prepubertal child. In: Emans SJ,
Laufer MR, Goldstein DP, eds. Pediatric and Adolescent Gynecology .
6th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2012:42–59.
Emans SJ, Woods ER. Vulvovaginal complaints in the adolescent. In:
Emans SJ, Laufer MR, Goldstein DP, eds. Pediatric and Adolescent