Empirical therapy for nonsevere PID

For empirical therapy in nonpregnant patients who do not have features of severe PID, as a 3-drug regimen, useOng, 2023:

ceftriaxone 500 mg intramuscularly or intravenously, as a single dose ceftriaxone ceftriaxone ceftriaxone

PLUS

metronidazole 400 mg orally, 12-hourly for 14 days metronidazole metronidazole metronidazole

PLUS EITHER

1doxycycline 100 mg orally, 12-hourly for 14 days doxycycline doxycycline doxycycline

OR for patients who are breastfeeding1 or likely to be nonadherent to doxycycline

2azithromycin 1 g orally, as a single dose, repeated 1 week later. azithromycin azithromycin azithromycin

For patients who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, use the regimen above.

For patients who have had a severe (immediate or delayed)2 hypersensitivity reaction to a penicillin, use metronidazole plus either doxycycline or azithromycin (as above). If Neisseria gonorrhoeae is identified, seek expert advice.

If the above regimens cannot be used and N. gonorrhoeae infection is excluded, considerBritish Association for Sexual Health and HIV (BASHH), 2019:

moxifloxacin 400 mg orally, daily for 14 days. For dosage adjustment in adults with kidney impairment, see moxifloxacin dosage adjustment. moxifloxacin moxifloxacin moxifloxacin

Assess the response to therapy within 72 hours and if the patient has not improved, review the diagnosis and consider switching to intravenous antibiotic therapy – see Empirical therapy for severe PID.

If Mycoplasma genitalium is detected, see PID caused by Mycoplasma genitalium.

If N. gonorrhoeae is identified, see Approach to Neisseria gonorrhoeae infection for information on additional testing (including test of cure) and contact tracing.

If C. trachomatis is identified, see Approach to Chlamydia trachomatis infection for information on additional testing (including test of cure) and contact tracing.

See also STI contact tracing.

1 Low levels of doxycycline are excreted in breast milk and pose a theoretical risk of enamel hypoplasia and staining of developing teeth in breastfed infants. A short single course (7 to 10 days) of doxycycline is considered safe in breastfeeding.Return
2 Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return