Pediatric Guidelines: Sexually Transmitted Infections (Adolescent) - Pelvic Inflammatory Disease

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Condition Major Pathogens First Choice Therapy Alternative Therapy Comments
Pelvic inflammatory disease, inpatient therapy

Chlamydia trachomatis

Neisseria gonorrhoeae

Enteric Gram negatives and anaerobes

Cefoxitin 2g/dose IV q6h

AND

Doxycycline 100mg/dose IV/PO q12h (PO preferred if tolerated)

24-48 hours after clinical improvement, can transition to Doxycycline monotherapy for completion of 14 day course

Beta lactam allergy:

Clindamycin 900mg/dose IV q8h 

AND 

Gentamicin 2mg/kg/dose IV x 1 followed by 1.5 mg/kg/dose IV q8h 

24-48 hours after clinical improvement, can transition to Doxycycline 100mg/dose PO BID for completion of 14 day course

 

If tubo-ovarian abscess is present:

Initial therapy as above. Upon discontinuing Cefoxitin, continue Doxycycline and ADD Metronidazole 500mg/dose PO BID for 14 day total course

If tubo-ovarian abscess is present:

Initial therapy as above. Complete course with combination of Doxycycline and Metronidazole 500mg/dose PO BID for 14 day total course

Pelvic inflammatory disease, outpatient therapy Same

Ceftriaxone 250mg IM x 1

AND

Doxycycline 100mg/dose PO BID x 14 days

Consider Metronidazole 500mg/dose PO BID x 14 days

If adherence is a concern the following regimen may be considered:

Ceftriaxone 250mg IM x 1

AND

Azithromycin 1g PO qweek x 2 doses

Contact ASP/Pediatric ID for guidance on alternatives for patients with beta lactam allergy

 
Reference: Workowski KA, Bolan GA, Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines, 2015. Morbid Mortal Recomm Rep 2015; 64:1-138.

These are guidelines only and not intended to replace clinical judgment. Modification of therapy may be indicated based on patient comorbidities, previous antibiotic therapy or infection history. Doses provided are usual doses but may require modification based on patient age or comorbid conditions. Refer to Pediatric Antimicrobial Dosing Guideline for further guidance on dosing in children, and Neonatal Dosing Guideline for infants < 1 month of age. Consult a pediatric pharmacist for individualized renal or hepatic dose adjustment. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP).