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 PLUS *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: PLUS Gentamicin IV 5 mg/kg once dailyc
If improvement after 24-48h, step-down: PLUS |
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 |
PLUS PLUS
If improvement after 24-48h, step-down: PLUS |
For severe penicillin allergy: PLUS Gentamicin IV 5 mg/kg once dailyc
If improvement after 24-48h, step-down: PLUS |
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).