Initial antibiotic therapy for severe PID

For patients with severe PID who have sepsis or septic shock, start antibiotic therapy within 1 hour of presentation to medical care or, for ward-based patients, development of sepsis or septic shock. Antibiotics should be administered immediately after blood samples are taken for culture. Collect an endocervical swab sample as soon as possible; however, do not delay antibiotic administration to do so. For nonantibiotic management of sepsis or septic shock, see Resuscitation of patients with sepsis or septic shock.

Rarely, patients who are critically ill may have infection caused by Streptococcus pyogenes (group A streptococcus [GAS]); see Streptococcus pyogenes bloodstream infections, including toxic shock syndrome.

Empirical regimens may need to be modified according to local epidemiology, if known, and consideration given to the potential relevance of the patient’s recent microbiology results. For patients with risk factors for infection with a multidrug-resistant gram-negative bacterium, seek advice from a clinical microbiologist or infectious diseases physician.

For empirical therapy in patients who are pregnant or who have features of severe PID, as a 3-drug regimen, useOng, 2023:

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 immediate² hypersensitivity reaction to a penicillin, the regimen above can be considered if a beta-lactam antibiotic is strongly preferred (for considerations, see Severe immediate hypersensitivity: Implications of cross-reactivity between penicillins and cephalosporins).

For patients who have had a severe immediate² hypersensitivity reaction to a penicillin in whom the regimen above is not used, or for patients who have had a severe delayed³ hypersensitivity reaction to a penicillin, as a 3-drug regimen, useOng, 2023Ross, 2017Savaris, 2020Workowski, 2021: