Pelvic Inflammatory Disease Organism-Specific Therapy 

Pelvic Inflammatory Disease Organism-Specific Therapy 

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All drug regimens used to treat pelvic inflammatory disease (PID) should be effective against Neisseria gonorrhoeae and Chlamydia trachomatis. [1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]

There is no agreement amongst experts on whether treatment of pelvic inflammatory disease should include anaerobic coverage. Outpatient regimens provided below have moderate coverage, while inpatient regimens have excellent coverage. Some experts recommend that all women should be covered for anaerobes, while others recommend that only women with severe disease requiring hospitalization, or those with tubo-ovarian abscesses should be covered. 

See the list below:

Doxycycline 100 mg IV or PO q12h for 14d or

Azithromycin 500 mg IV for 1-2 doses, followed by 250 mg PO for 5-6d

See the list below:

Uncomplicated gonorrhea [5] : Ceftriaxone 250 mg IM plus  either azithromycin 1 g PO as a single dose or doxycycline 100 mg PO q12h for 7d or

Ceftriaxone 1 g IV q24h or

Cefoxitin 2 g IV q6h or

Cefotetan 2 g IV q12h

If N gonorrhoeae is the suspected pathogen, fluoroquinolones are no longer recommended secondary to increased resistance

Cefixime is no longer recommended at any dose as first-line treatment of gonococcal infections [4, 5] ; if used as an alternative agent, cefixime 400 mg PO plus  either azithromycin 1 g PO as a single dose or doxycycline 100 mg PO q12h × 7 days (Patients should return in 1 week for a test-of-cure at the infection site.) [5]

See the list below:

Cefoxitin 2 g IV q6h or

Cefotetan 2 g IV q12h or

Metronidazole 500 mg PO q12h or

Ampicillin-sulbactam 3 g IV q6h

See the list below:

Cefoxitin 2 g IV q6h or

Cefotetan 2 g IV q12h or

Gentamicin IV or IM 2 mg/kg loading dose, followed by 1.5 mg/kg q8h maintenance dose

Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res. 2003 Jan-Feb. 31(1):45-54. [Medline].

Centers for Disease Control and Prevention. Sexually transmitted diseases treatment guidelines 2002. MMWR Recomm Rep. 2002 May 10. 51(RR-6):1-78. [Medline].

Centers for Disease Control and Prevention. Update to CDC’s sexually transmitted diseases treatment guidelines, 2006: fluoroquinolones no longer recommended for treatment of gonococcal infections. MMWR Morb Mortal Wkly Rep. 2007 Apr 13. 56(14):332-6. [Medline].

[Guideline] Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [Medline]. [Full Text].

Centers for Disease Control and Prevention (CDC). Update to CDC’s Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections. MMWR Morb Mortal Wkly Rep. 2012 Aug 10. 61(31):590-4. [Medline].

Workowski KA, Berman S. Sexually transmitted diseases treatment guidelines, 2010. MMWR Recomm Rep. 2010 Dec 17. 59:1-110. [Medline].

U.S. Preventive Services Task Force. Screening for chlamydial infection: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2007 Jul 17. 147(2):128-34. [Medline].

Ness RB, Soper DE, Holley RL, et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol. 2002 May. 186(5):929-37. [Medline].

Savaris RF, Teixeira LM, Torres TG, et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007 Jul. 110(1):53-60. [Medline].

Walker CK, Wiesenfeld HC. Antibiotic therapy for acute pelvic inflammatory disease: the 2006 Centers for Disease Control and Prevention sexually transmitted diseases treatment guidelines. Clin Infect Dis. 2007 Apr 1. 44 Suppl 3:S111-22. [Medline].

Asicioglu O, Gungorduk K, Ozdemir A, Ertas IE, Yildirim G, Sanci M, et al. Single daily dose of moxifloxacin versus ofloxacin plus metronidazole as a new treatment approach to uncomplicated pelvic inflammatory disease: a multicentre prospective randomized trial. Eur J Obstet Gynecol Reprod Biol. 2013 Nov. 171(1):116-21. [Medline].

Chen C, Chen Y, Wu P, Chen B. Update on new medicinal applications of gentamicin: evidence-based review. J Formos Med Assoc. 2014 Feb. 113(2):72-82. [Medline].

Haggerty CL, Totten PA, Tang G, Astete SG, Ferris MJ, Norori J, et al. Identification of novel microbes associated with pelvic inflammatory disease and infertility. Sex Transm Infect. 2016 Sep. 92 (6):441-6. [Medline]. [Full Text].

Savaris RF, Fuhrich DG, Duarte RV, Franik S, Ross J. Antibiotic therapy for pelvic inflammatory disease. Cochrane Database Syst Rev. 2017 Apr 24. 4:CD010285. [Medline]. [Full Text].

Das BB, Ronda J, Trent M. Pelvic inflammatory disease: improving awareness, prevention, and treatment. Infect Drug Resist. 2016. 9:191-7. [Medline]. [Full Text].

Ritu Kumar, MD Resident, Department of Emergency Medicine, Hospital of the University of Pennsylvania

Ritu Kumar, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Student Association/Foundation, Society for Academic Emergency Medicine, Emergency Medicine Residents’ Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Pelvic Inflammatory Disease Organism-Specific Therapy 

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