Acute Pelvic Inflammatory Disease

These materials are intended for general clinical education and guidance. They are not a substitute for a clinician’s knowledge, skill or judgment in treating patients.

Preferred treatments

Outpatient/Emergency Department:

• Ceftriaxone 500 mg IM/IV as a single dose

AND

• Doxycycline 100 mg PO bid for 14 days

AND

• Metronidazole 500 mg PO bid for 14 days

Inpatient:

• Ceftriaxone 1 g IV every 24 hours

AND

• Doxycycline 100 mg PO bid

AND

• Metronidazole 500 mg IV/PO bid

When clinically improved, transition to the following to complete 14 days: 

• Doxycycline 100 mg PO bid 

AND

• Metronidazole 500 mg PO bid

Alternative treatments

Consult Infectious Diseases if the first-line outpatient regimen cannot be used. 

Inpatient (for cephalosporin allergy):

• Clindamycin 900 mg IV every eight hours 

PLUS 

• Gentamicin 3–5 mg/kg IV every 24 hours

When clinically improved, transition to the following to complete 14 days: 

• Clindamycin 450 mg PO QID

OR

• Doxycycline 100 mg PO bid 

PLUS

• Metronidazole 500 mg PO bid

Pregnancy

Consult Obstetrics: PID is uncommon during pregnancy, and there is a broad differential diagnosis for acute abdominal pain in pregnancy.

Follow-up recommendations

• Outpatients should be evaluated two to three days after treatment initiation. If symptoms do not improve, further work-up is needed and hospital admission for parenteral therapy may be required
• Patients should abstain from sexual intercourse until treatment is completed, symptoms have resolved and partners have been treated (see below)
• All patients diagnosed with PID should be tested for Neisseria gonorrhoeae, Chlamydia trachomatis, HIV and syphilis

Testing and treatment of sexual contacts

• All partners who have had sexual contact with an index case of PID in the past 60 days should be evaluated, tested and presumptively treated for chlamydia and gonorrhea
• If the last sexual contact occurred more than 60 days from PID diagnosis or symptom onset, the most recent sexual partner should be evaluated, tested and presumptively treated for chlamydia and gonorrhea