This and other STI sections are not meant to be comprehensive references for all STI treatment but primarily focused on the most commonly used initial empiric antimicrobial therapy. Users should refer to linked resources (SFDPH City Clinic protocols, CDC guidelines) or other local resources to provide patients and their partners appropriate counseling and follow-up. For non-adolescent age patients, patients with STIs not addressed in these guidelines, or patients with contraindications to the listed therapies, we recommend referring to the linked resources, or Lexi-Comp for medication information, or consulting ID/ASP for individualized recommendations.
| Condition | Major Pathogens | First Choice Therapy | Alternative Therapy | Comments |
|---|---|---|---|---|
|
Pelvic inflammatory disease, inpatient therapy Need for inpatient therapy is based on clinical judgment and meeting any suggested criteria: Surgical emergencies (e.g., appendicitis) cannot be excluded Severe PID (vomiting, severe pain, high fever, overt peritonitis) Tubo-ovarian abscess Pregnancy Inability to follow or tolerate outpatient regimen Treatment failure on appropriate outpatient regimen |
Often polymicrobial Chlamydia trachomatis Neisseria gonorrhoeae Enteric gram-negative and anaerobic bacteria |
Cefoxitin AND Doxycycline 24 hours after clinical improvement: Stop Cefoxitin, continue Doxycycline 100 mg enterally bid, and ADD Metronidazole 500 mg enterally bid to complete 14 day total course* |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Clindamycin AND Gentamicin 24 hours after clinical improvement: Stop Clindamycin and Gentamicin, start Doxycycline 100 mg enterally bid and Metronidazole 500 mg enterally bid to complete 14 day total course |
Refer to SFDPH City Clinic STI protocols section on PID for diagnostic criteria, recommended laboratory evaluation (including testing for other STIs), counseling (including abstinence from sex during treatment), partner treatment, and follow up (including retesting in 3 months). *Metronidazole likely improves outcomes in all patients with PID, and is especially indicated if bacterial vaginosis or tubo-ovarian abscess cannot be ruled out |
|
Pelvic inflammatory disease, outpatient therapy Outpatient treatment is standard in those patients with mild to moderate symptoms and able to return for frequent reassessment. All patients who begin outpatient treatment should be clinically re-evaluated within 72 hours and if not improved should start parenteral therapy and consider additional diagnostics |
Same |
Ceftriaxone Weight > 45 kg and <150kg: 500 mg IM x 1 dose Weight >=150kg: AND Doxycycline AND Metronidazole |
Penicillin or cephalosporin allergy with higher risk for allergic reaction: Consult ID/ASP If anticipate significant challenges to adherence: Consider replacing Doxycycline with: Azithromycin |
Refer to SFDPH City Clinic STI protocols section on PID for diagnostic criteria, evaluation, counseling, and follow up recommendations *Metronidazole likely improves outcomes in all patients with PID, and is especially indicated if bacterial vaginosis or tubo-ovarian abscess cannot be ruled out |
References:
Workowski KA, et al. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep 2021;70:1-187.
Wiesenfeld, HC, et al.. (2020). A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis 2020;72;1181-1189.
St. Cyr S, et al. Update to CDC’s treatment guidelines for gonococcal infection, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1911–1916.
Pediatric Empiric Antimicrobial Therapy Guidelines
This is a subsection of the UCSF Benioff Children’s Hospitals Empiric Antimicrobial Therapy Guidelines, developed by the Pediatric Antimicrobial Stewardship Programs at each campus to inform initial selection of empiric antimicrobial therapy for children at the UCSF Benioff Children’s Hospitals and affiliated outpatient sites.
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. Durations provided are usual recommendations for patients who are responding appropriately to therapy. For additional guidance, please contact Pediatric Infectious Diseases (ID) or the Pediatric Antimicrobial Stewardship Program (ASP) at the campus where your patient is receiving care.
For questions or feedback about these guidelines, please email primary content owners, Rachel Wattier, Pediatric ASP Medical Director at BCH SF and Prachi Singh, Pediatric ASP Medical Director at BCH OAK.
The content of these guidelines was updated in July 2021. See Summary and Rationale for Changes (password login to Box needed) for detailed explanations of the content changes.