Modification and duration of therapy for severe PID

Pharmacokinetics may be altered in patients who are critically ill (eg because of enhanced kidney clearance or changes in volume of distribution). To ensure adequate drug exposure in patients with severe PID who have septic shock or require intensive care support, a modified dosage of ceftriaxone is recommended. Once the critical illness has resolved, consider switching to the standard dosage.

Modify therapy based on the results of culture and susceptibility testing.

If the results of susceptibility testing are not available by 72 hours after the initial empirical antibiotic dose, intravenous therapy is still required, and gentamicin or tobramycin was used initially, seek expert advice.

Switch to oral antibiotic therapy once the patient is clinically stable and able to tolerate and absorb oral therapy – see Guidance for intravenous to oral switch. Oral therapy should be based on the results of culture and susceptibility testing.

For patients who received ceftriaxone, switch to oral metronidazole plus either doxycycline (for nonpregnant patients) or azithromycin (as for Empirical therapy for nonsevere PID) to complete a total treatment duration (intravenous + oral) of 14 days.

For patients in whom ceftriaxone was not used, seek expert advice for guidance on appropriate oral regimens to complete the course of therapy.

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

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

If Chlamydia 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.