American Board of Internal Medicine (ABIM) Certification Practice Exam

What additional treatment can be used alongside cefoxitin for pelvic inflammatory disease?

1. Ciprofloxacin

2. Metronidazole

3. Acyclovir

4. Clindamycin

The correct answer is: Metronidazole

In the treatment of pelvic inflammatory disease (PID), cefoxitin is often used as a part of the combination therapy to cover a broad range of bacteria, including both aerobic and anaerobic organisms. Incorporating metronidazole alongside cefoxitin enhances the treatment regimen by effectively targeting anaerobic bacteria, which are commonly involved in PID. Metronidazole is particularly useful for its efficacy against organisms such as Gardnerella vaginalis and Bacteroides species, which can contribute to the infection. Using cefoxitin alone may not be sufficient due to the possibility of anaerobic infections, which metronidazole can address. This combination aims to provide a more comprehensive coverage to improve treatment outcomes and reduce complications. Ciprofloxacin would not complement cefoxitin effectively, as it focuses predominantly on certain aerobic bacteria and would not provide the additional anaerobic coverage that metronidazole does. Acyclovir is an antiviral medication and does not play a role in treating bacterial infections like PID. Clindamycin, while effective against anaerobes, is not typically used in combination with cefoxitin in the standard treatment regimen for PID, as metronidazole is preferred for this purpose.