Pelvic Inflammatory Disease

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
2000 mg IV q6h 

AND 

Doxycycline
100 mg enterally or IV q12h (enteral route preferred if tolerated) 

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
900 mg IV q8h  

AND  

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

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 

Ceftriaxone 

Weight > 45 kg and <150kg: 500 mg IM x 1 dose 

Weight >=150kg: 
1000 mg IM x 1 dose 

AND 

Doxycycline
100 mg enterally bid x 14 days 

AND  

Metronidazole
500 mg enterally bid x 14 days* 

Penicillin or cephalosporin allergy with higher risk for allergic reaction:  

Consult ID/ASP

If anticipate significant challenges to adherence:

Consider replacing Doxycycline with: 

Azithromycin
1000 mg enterally qweek x 2 doses 

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