Approach to managing postprocedural pelvic infection

The choice of empirical antibiotic therapy for postprocedural pelvic infection depends on the cause and the likelihood of a sexually transmissible infection (STI) and related complications.

For specific management advice, see:

• Intra-amniotic infection (chorioamnionitis)
• Postpartum endometritis
• Septic abortion for pelvic infection following either spontaneous abortion (miscarriage) or induced abortion (surgical, unsafe, or rarely, medical)
• Treatment of pelvic inflammatory disease for
  • pelvic infection following other transvaginal gynaecological procedures (including within the first 20 days after insertion of an intrauterine contraceptive device [IUD]) if STIs cannot be reliably excluded (eg the patient is sexually active and STIs could have been contracted after screening or patient was not investigated for STIs before the procedure)
  • patients with pelvic infection occurring more than 20 days after IUD insertion
  • other causes of PID, if STIs cannot be excluded
• Treatment of postprocedural pelvic infection for pelvic infection following other transvaginal gynaecological procedures (including within the first 20 days after IUD insertion) if STIs have been reliably excluded.

For additional considerations for patients with an intrauterine contraceptive device, see Considerations for patients with an intrauterine contraceptive device.

Initial intravenous therapy is usually required for patients who are pregnant or who have any of the following features of severe postprocedural pelvic infectionWorkowski, 2021:

• inability to tolerate oral therapy
• severe pain
• fever (38°C or higher)
• systemic features (eg tachycardia, vomiting)
• sepsis or septic shock
• suspicion of tubo-ovarian abscessChappell, 2012.

Oral therapy for postprocedural pelvic infection is appropriate for nonpregnant patients who do not have any of the above features.