Health Library Antibiotics for Pelvic Inflammatory DiseaseFrom Healthwise

Pelvic inflammatory disease (PID) is often caused by a combination of different types of bacteria, so a combination (regimen) of medications is used to treat the infection. Treatment changes as new medications are developed or as the bacteria that cause the infection become resistant to old medications. Treatment guidelines from the U.S. Centers for Disease Control and Prevention recommend one of the following regimens. (If you live in California or Hawaii, or you or your partner have recently traveled abroad, see regimen B.):¹

· Outpatient treatment, regimen A

Ofloxacin or levofloxacin with or without metronidazole

Ofloxacin is taken as pills twice a day for 14 days. Levofloxacin is taken as pills once a day for 14 days. These medications are not used if you are pregnant. Metronidazole is taken as pills twice a day for 14 days. Do not drink alcohol when taking metronidazole.

· Outpatient treatment, regimen B

In California and Hawaii, there are higher-than-normal rates of gonorrhea that are not cured by some antibiotics. For this reason, Regimen B is recommended as first-line treatment for gonorrhea in these states.

One of the following three cephalosporin treatments is used along with doxycycline.

Ceftriaxone plus doxycycline

Ceftriaxone is given one time as an injection in a muscle. Doxycycline is taken as pills twice a day for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline.

OR:

Cefoxitin with probenecid plus doxycycline

Cefoxitin is given one time as an injection in a muscle. Probenecid is taken as a pill in a single dose at the time of the shot. Doxycycline is taken as pills twice a day for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline.

Other antibiotic medicines are sometimes used for treating PID.

Inpatient treatment

Some women need to be hospitalized for pelvic inflammatory disease treatment. In the hospital, antibiotics are first given through a vein (intravenous, or IV) for at least 24 hours, followed by antibiotics by mouth, which are continued at home after discharge from the hospital. Total medication treatment lasts for 14 days.²

· Inpatient intravenous, regimen A

Cefotetan

Cefotetan is given intravenously every 12 hours.

OR:

Cefoxitin plus doxycycline

Cefoxitin is given intravenously every 6 hours. Doxycycline is given intravenously or in pill form every 12 hours.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline or clindamycin) are given.

· Inpatient intravenous, regimen B

Clindamycin is given intravenously every 8 hours. Gentamicin is given intravenously or by injection every 8 hours or once a day.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline or clindamycin) are given.

Antibiotics kill the various bacteria that cause PID.

Antibiotics are used if you have one or more signs of PID and you are at risk for PID.

• There is recent onset of lower pelvic tenderness or pain, especially if it is on both sides.
• There is recent onset of pain or tenderness when the fallopian tubes or ovaries are touched or moved during examination.
• There is pain or tenderness when the cervix is moved during examination.

Not all women who have PID will have pelvic pain. This is why many experts say that women should be treated for PID if they are at risk for PID and have pain when the cervix is moved, especially if there is an abnormal cervical discharge.

Antibiotic treatment kills the bacteria causing PID. The risks of a future tubal pregnancy (ectopic pregnancy), ongoing (chronic) pelvic pain, and infertility are less if you start treatment early.

The common side effects of the antibiotics recommended for PID include:

• Nausea or vomiting.
• Diarrhea.
• Rash.
• Headache.
• Fatigue.
• Dizziness.
• Yeast infection.

Each antibiotic medication for PID may have specific side effects or interactions with other medications.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

If side effects from the medication treatment occur, report them to your health professional. Other antibiotics may be prescribed that cause fewer side effects.

Antibiotics can prevent PID complications when started early and when all the medication is taken.

Tell your health professional if you think you might be pregnant. Some antibiotics are not recommended during pregnancy.

A follow-up examination should be performed 2 to 3 days after you start treatment. You should have less pain and tenderness during an abdominal and pelvic exam. Follow-up exams at 7 to 10 days and 4 to 6 weeks are usually recommended to make sure treatment is successful.

If your symptoms have not improved, your health professional may try another medication regimen or look for other possible causes of your symptoms, including ectopic pregnancy, appendicitis, pelvic abscess, or endometriosis.

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Citations

1. Centers for Disease Control and Prevention (2006). Pelvic inflammatory disease section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 56–61.

2. American Academy of Pediatrics (2003). Pelvic inflammatory disease. In LK Pickering, ed., Red Book: 2003 Report of the Committee on Infectious Diseases, 26th ed., pp. 468–472. Elk Grove Village, IL: American Academy of Pediatrics.

Author:	Kathe Gallagher, MSW	Last Updated: November 28, 2006
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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