Regimens for Treatment of Pelvic Inflammatory Disease*
Treatment | Recommended Regimens | Alternative Regimens |
|---|---|---|
Parenteral† | Regimen A: Ceftriaxone 1 g IV every 24 hours PLUS Doxycycline 100 mg orally or IV every 12 hours PLUS Metronidazole 500 mg orally or IV every 12 hours Regimen B: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 | Regimen C: Ampicillin/sulbactam 3 g IV every 6 hours PLUS Doxycycline 100 mg orally or IV every 12 hours Regimen D: Clindamycin 900 mg IV every 8 hours PLUS Gentamicin 2 mg/kg IV or IM (loading dose), followed by 1.5 mg/kg every 8 hours (maintenance dose); can be substituted with single daily dosing (3–5 mg/kg once a day) |
Oral or IM† | Regimen A:Ceftriaxone 500 mg IM in a single dose‡ PLUS Doxycycline 100 mg orally twice a day for 14 days WITH Metronidazole 500 mg orally twice a day for 14 days Regimen B: Cefoxitin 2 g IM in a single dose with probenecid 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH Metronidazole 500 mg orally twice a day for 14 days Regimen C: Other parenteral 3rd-generation cephalosporin (eg, ceftizoxime, cefotaxime) PLUS Doxycycline 100 mg orally twice a day for 14 days WITH Metronidazole 500 mg orally twice a day for 14 days | Regimen D§:Levofloxacin 500 mg orally once a day for 14 days OR Moxifloxacin 400 mg orally once a day for 14 days WITH Metronidazole 500 mg orally twice a day for 14 days Regimen E:Azithromycin 500 mg IV once a day in 1 or 2 doses, followed by 250 mg orally once a day for a total duration of 7 days WITH OR WITHOUT Metronidazole 500 mg orally twice a day for 12 to 14 days |
* Recommendations are from the Centers for Disease Control and Prevention. Workowski KA, Bachmann LH, Chan PA, et al: Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 70(4):1-187, 2021 doi:10.15585/mmwr.rr7004a1 | ||
† Intramuscular or oral therapy can be considered for mild to moderate acute PID because the clinical outcomes with intramuscular/oral and parenteral therapy are similar. If patients do not respond to oral therapy within 72 hours, they should be reevaluated to confirm the diagnosis, and intravenous therapy should be given. | ||
‡ If patient weighs > 150 kg with documented gonococcal infection, 1 g of ceftriaxone should be administered. | ||
§ This regimen may be considered if the patient has a cephalosporin allergy, if community prevalence and individual risk of gonorrhea are low, and if follow-up is likely. Tests for gonorrhea must be done before therapy is started, and the following management is recommended:
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