Antimicrobial therapy for pelvic inflammatory disease in adults and adolescents

This algorithm represents our approach to antimicrobial selection for nonpregnant patients with PID. Treatment should be tailored to the individual. Refer to other UpToDate content on PID therapy for details on and doses for alternative regimens, including management of PID in pregnant individuals (which is uncommon).

IM: intramuscular; IV: intravenous; PID: pelvic inflammatory disease.

* Alternative regimens include clindamycin plus gentamicin, ampicillin-sulbactam plus doxycycline, and if Neisseria gonorrhoeae has been ruled out, azithromycin plus metronidazole. Because of various drawbacks, we reserve these for patients who cannot take preferred regimens.

¶ We prefer ceftriaxone because it has the best and most established activity against N. gonorrhoeae. Other appropriate long-acting intramuscular cephalosporins include cefoxitin (with probenecid), cefotaxime, and ceftizoxime.

Δ Doxycycline and metronidazole can also be given intravenously at the same doses for those who cannot take oral medications.

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Antimicrobial therapy for pelvic inflammatory disease in adults and adolescents