Pelvic Inflammatory Disease (PID)

Choice of Antimicrobials

Indication for Therapy	Usual Causative Organisms	Antimicrobial Regimens
Ambulatory (outpatient)	Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Enterobacterales	cefTRIAXone 250 mg IM x 1 dose + doxycycline^‡ 100 mg PO q12h x 14 days +/- metroNIDAZOLE^* 500 mg PO q12h x 14 days
Severe, requiring hospitalization	Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Enterobacterales	cefTRIAXone^† 1 g IV q24h + metroNIDAZOLE^† 500 mg IV/PO q12h + doxycycline^‡ 100 mg PO q12h
β-lactam allergy (anaphylaxis): clindamycin^† 900 mg IV q8h + tobramycin (as per hospital guidelines)^†

Ambulatory (outpatient)

Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Enterobacterales

cefTRIAXone 250 mg IM x 1 dose
+
doxycycline^‡ 100 mg PO q12h x 14 days
+/-
metroNIDAZOLE^* 500 mg PO q12h x 14 days

Severe, requiring hospitalization

Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, Enterobacterales

cefTRIAXone^† 1 g IV q24h
+
metroNIDAZOLE^† 500 mg IV/PO q12h
+
doxycycline^‡ 100 mg PO q12h

β-lactam allergy (anaphylaxis):

clindamycin^† 900 mg IV q8h
+
tobramycin (as per hospital guidelines)^†

^* metroNIDAZOLE should be added if a tuboovarian abscess is suspected.

† When patient clinically improved, step down to oral antibiotic therapy with doxycycline 100 mg PO q12h or clindamycin 450 mg PO q6h or amoxicillin/clavulanic acid 875/125 mg PO q12h (clindamycin or amoxicillin/clavulanic acid preferred if tuboovarian abscess suspected) x 14 days total.

^‡ Doxycycline should not be used in pregnant woman >15 weeks gestational age.

References

Canadian Guidelines on Sexually Transmitted Infections, January 2010 Edition. Ottawa, ON: Public Health Agency of Canada, 2010. Available at: http://www.phac-aspc.gc.ca/std-mts/sti-its/pdf/sti-its-eng.pdf
Public Health Agency of Canada update on the Treatment of Gonococcal Infections. Available at: http://www.phac-aspc.gc.ca/std-mts/sti-its/alert/2011/alert-gono-eng.php
Supplementary statement for recommendations related to the diagnosis, management, and follow-up of pelvic inflammatory disease. Available at: http://www.phac-aspc.gc.ca/std-mts/sti-its/cgsti-ldcits/assets/pdf/pid-aip-eng.pdf