Pelvic Inflammatory Disease

Patient Population: Adult
Empiric treatment recommendations for adult patients with Pelvic Inflammatory Disease (PID) with or without Tubo-Ovarian Abscess (TOA).

Note: Post-operative pelvic abscess should be treated as a post-operative abdominal abscess (see IDMP empiric dosing recommendations). 

Diagnosis Common Pathogens Drug(s) of First Choicea Alternative Drug(s)a Comments Expected Durationb
Pelvic Inflammatory Disease (mild-moderate, outpatient)

Anaerobes 

Enteric GNRs 

G. vaginalis 

H. influenzae 

Streptococcus agalactiae

Ceftriaxone 500 mg IM x1* 

PLUS 

Doxycycline 

PLUS 

Metronidazole 

*For >150 kg with documented gonococcal infection, use ceftriaxone 1 g.

*If Inpatient with IV access, may use 1 g IV regardless of body weight to avoid painful IM injection.

For severe penicillin allergy:

Clindamycin

PLUS  

Gentamicin IV 5 mg/kg once dailyc  

 

If improvement after 24-48h, step-down

Doxycycline

Step down to PO if improving after 24-28h on parenteral regimen 14 days

Pelvic Inflammatory Disease (severe, hospitalized) 

+/- Tubo-Ovarian Abscess (TOA) 

Anaerobes 

Enteric GNRs 

G. vaginalis 

H. influenzae 

Streptococcus agalactiae

Ceftriaxone

PLUS  

Doxycycline

PLUS 

Metronidazole 

 

If improvement after 24-48h, step-down:

Doxycycline

PLUS

Metronidazole

For severe penicillin allergy:

Clindamycin

PLUS  

Gentamicin IV 5 mg/kg once dailyc  

 

If improvement after 24-48h, step-down

Doxycycline

If TOA, add metronidazole

Step down to PO if improving after 24-28h on parenteral regimen 

If TOA, surgical drainage may be necessary

14 days

a Dosing assumes normal renal function, adjustments for renal impairment may apply.

b Total duration should include effective IV days of therapy.

c If normal renal function, start with gentamicin 5 mg/kg once daily and then adjust per Urban-Craig nomogram (high dose, extended interval dosing). If renal impairment, dose gentamicin to target peak 6-8 and trough <1 (traditional dosing).

*Note that drug shortages may dictate supplies and preferred regimens may adjust as needed.

Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. 2021;70(4).