Pelvic Inflammatory Disease: Outpatient and Inpatient Treatment Protocols

- For healthcare professionals only.

The Centers for Disease Control and Prevention (CDC) has outlined antibiotic treatment protocols for outpatient and inpatient treatment of PID. These are summarised below for ease of reference for healthcare professionals.

Outpatient treatment

The CDC lists two currently recommended intravenous and oral or intramuscular and oral treatment protocols, labeled as A and B. The intramuscular and oral regimens are detailed below since it is more convenient and cost effective for outpatient use in most African clinical situations.

Regimen A consists of the following:

• Ceftriaxone 500 mg intramuscularly (IM) once as a single dose plus
• Doxycycline 100 mg orally 2 times daily for 14 days
• Metronidazole 500 mg orally 2 times daily for 14 days can be added if there is evidence or suspicion of vaginitis or if the patient underwent gynecologic instrumentation in the preceding 2-3 weeks

Regimen B consists of the following:

• Cefoxitin 2 g IM once as a single dose concurrently with probenecid 1 g orally in a single dose, or another single-dose parenteral third-generation cephalosporin (eg, ceftizoxime or cefotaxime) plus
• Doxycycline 100 mg orally 2 times daily for 14 days
• Metronidazole 500 mg 2 times twice daily for 14 days can be added if there is evidence or suspicion of vaginitis or if the patient underwent gynecologic instrumentation in the preceding 2-3 weeks

Inpatient treatment

For inpatient treatment of PID, the CDC also lists 2 currently accepted treatment regimens, again labeled as A and B. 

Regimen A consists of the following:

• Cefoxitin 2 g IV every 6 hours or cefotetan 2 g IV every 12 hours plus
• Doxycycline 100 mg orally or IV every 12 hours

This regimen is continued for 24 hours after the patient remains clinically improved, after which doxycycline 100 mg is given orally twice daily for a total of 14 days. If a TOA is present, clindamycin or metronidazole is used with doxycycline for more effective anaerobic coverage.

Regimen B consists of the following:

• Clindamycin 900 mg IV every 8 hours plus
• Gentamicin IV in a loading dose of 2 mg/kg, followed by a maintenance dosage of 1.5 mg/kg 8hrly.

IV therapy may be discontinued 24 hours after the patient improves clinically, and oral therapy with 100 mg doxycycline twice daily should be continued for a total of 14 days. If tubo-ovarian abscess (TOA) is present, clindamycin or metronidazole may be used with doxycycline for more effective anaerobic coverage.

An alternative parenteral regimen is ampicillin-sulbactam 3 g IV every 6 hours in conjunction with doxycycline 100 mg orally or IV every 12 hours.

Reference:

CDC: Pelvic Inflammatory Disease: Treatment Guidelines. 2021. Retrieved March 10, 2023.

Published: March 5, 2023

© 2023. Datelinehealth Africa Inc. All rights reserved.

Permission is given to freely copy, use and share content without modification or alteration and subject to attribution as to source.