Treatment of inflammatory infiltrates in the pelvic cavity: Opportunities and effectiveness of local therapy

Inflammatory infiltrates in the pelvic cavity represent a significant complication of pelvic inflammatory disease (PID), often leading to prolonged hospitalization, increased pain, and long-term sequelae such as adhesions. This original prospective study, conducted from January 2014 to December 2016, evaluated the efficacy of adding rectal suppositories containing streptokinase (15,000 IU) and streptodornase (1,250 IU) to standard international guideline-based treatment in 225 patients with confirmed pelvic inflammatory infiltrates. Patients provided informed consent and were randomized into two groups: Group 1 (n=110) received standard therapy, while Group 2 (n=115) received standard therapy plus the suppositories. The regimen for suppositories varied by disease severity: for severe cases, 1 suppository three times daily for 3 days, then twice daily for 3 days, then once daily for 3 days; for moderate to mild cases, twice daily for 3 days, then once daily for 4 days or twice daily for 2 days. Group 2 demonstrated superior outcomes, including faster reduction in infiltrate volume (p<0.01 at days 7 and 14), reduced hospital stay (mean 12.4 vs 15.8 days, p<0.001), fewer severe cases (8% vs 18%, p<0.05), fewer complications (6% vs 14%, p<0.05), and lower pain scores (p<0.01 at multiple timepoints). Adhesion formation was lower in Group 2 at 3, 6, and 12 months post-recovery (p<0.05). Mild local reactions occurred in 12 patients in Group 2, resolving spontaneously without intervention. These findings suggest that adjunctive local fibrinolytic therapy enhances treatment efficacy in pelvic inflammatory infiltrates.