Pelvic Inflammatory Disease Treatment Guidelines
Outpatient Treatment Options
- The Centers for Disease Control and Prevention recommends outpatient treatment of PID with either a cephalosporin plus doxycycline with or without metronidazole, or a fluoroquinolone with metronidazole for 14 days 1, 2
- Ofloxacin 400 mg orally twice daily for 14 days or Levofloxacin 500 mg orally once daily for 14 days, with metronidazole 500 mg orally twice daily for 14 days, is a recommended regimen 1, 2
- Ceftriaxone 250 mg IM in a single dose or Cefoxitin 2 g IM with Probenecid 1 g orally in a single dose, plus Doxycycline 100 mg orally twice daily for 14 days, with or without metronidazole 500 mg orally twice daily for 14 days, is an alternative regimen 1, 2
Rationale for Treatment Components
- Ceftriaxone or Cefoxitin provides coverage against N. gonorrhoeae, with ceftriaxone having better coverage 1, 2
- Ofloxacin or Levofloxacin is effective against both N. gonorrhoeae and C. trachomatis 1, 2
- Doxycycline targets C. trachomatis 1, 2
- Metronidazole provides anaerobic coverage and treats bacterial vaginosis, which is frequently associated with PID 1, 2
Important Clinical Considerations
- Patients should demonstrate substantial clinical improvement within 3 days of starting therapy, including defervescence, reduction in abdominal tenderness, and reduction in cervical motion tenderness 1, 2
- If no improvement within 72 hours, patients should be reevaluated, hospitalized for parenteral therapy, and further diagnostic tests should be performed 1, 2
Inpatient Treatment Options
- Cefotetan 2 g IV every 12 hours or Cefoxitin 2 g IV every 6 hours, plus Doxycycline 100 mg IV or orally every 12 hours, is a recommended parenteral regimen 1, 3
- Clindamycin 900 mg IV every 8 hours, plus Gentamicin loading dose IV or IM, followed by maintenance dose, is an alternative parenteral regimen 1, 3
Management of Sex Partners
- Sex partners of patients with PID should be examined and treated if they had sexual contact with the patient during the 60 days preceding onset of symptoms, due to risk of reinfection and likelihood of urethral gonococcal or chlamydial infection 1, 2
- Sex partners should be treated empirically with regimens effective against both C. trachomatis and N. gonorrhoeae, regardless of the etiology of PID 1, 2
Follow-Up Recommendations
- A follow-up examination should be performed within 72 hours for patients on outpatient therapy 1, 2
- Parenteral therapy can be discontinued 24 hours after clinical improvement, with continuing oral therapy to complete a total of 14 days 1, 3