Moderate-severe
- Hospitalization should be considered if:
- severe illness or high fever present
- not responding to therapy (72 hours)
- unable to tolerate oral medications or noncompliant
- pregnant
- advanced HIV (CD4 < 200)
- adnexal mass/tubo-ovarian abscess
- need for laparoscopy to clarify diagnosis i.e. to rule out acute appendicitis.
- PID is not an indication for IUD removal. If IUD removal is planned however, delay removal until at least two doses of antibiotics have been administered.
Usual Pathogens
N. gonorrhoeae
C. trachomatis
Mycoplasmoides genitalium (previously Mycoplasma genitalium)
Polymicrobial:
Enterobacterales
Anaerobes
Streptococcus spp
Haemophilus spp
Gardnerella vaginalis
Rare:
Herpes simplex virus
Trichomonas vaginalis
| Empiric Therapy | Duration | |
|---|---|---|
| [Ceftriaxone | 1-2g IV daily | Until 24 hours after clinical improvement then switch to oral |
| + | ||
| Doxycycline | 100mg IV/PO bid | |
| + | ||
| Metronidazole] | 500mg IV/PO bid | |
| or | ||
| [Cefoxitin | 2g IV q6h | Until 24 hours after clinical improvement then switch to oral |
| + | ||
| Doxycycline] | 100mg IV/PO bid |
Ceftriaxone and cefoxitin allergy
| Empiric Therapy | Duration | |
|---|---|---|
| Clindamycin | 900mg IV q8h | Until 24 hours after clinical improvement then switch to oral |
| + | ||
| Gentamicin | 5-7mg/kg IV q24h |
Severe
| Empiric Therapy | Duration | |
|---|---|---|
| Piperacillin-tazobactam | 3.375g IV q6h | Until 24 hours after clinical improvement then switch to oral |
| + | ||
| Doxycycline | 100mg IV/PO bid |
Oral stepdown
| Empiric Therapy | Duration | |
|---|---|---|
| Doxycycline | 100mg PO bid | To complete at least 14 days |
| +/- | ||
| Metronidazole | 500mg PO bid | To complete at least 14 days |
Alternative
| Empiric Therapy | Duration | |
|---|---|---|
| Levofloxacin | 500-750mg PO daily | To complete at least 14 days |
| + | ||
| Azithromycin | 2g PO | 1 dose |
| + | ||
| Metronidazole | 500mg PO bid | To complete at least 14 days |