From the Research
The management of an infected intrauterine device (IUD) typically requires removal of the device and antibiotic therapy, with the first-line regimen being ceftriaxone 250mg IM as a single dose plus doxycycline 100mg orally twice daily for 14 days, with metronidazole 500mg orally twice daily for 14 days added for better anaerobic coverage, as supported by the most recent study 1. The IUD should be removed promptly when infection is suspected, as this is essential for resolution of the infection.
- The combination of ceftriaxone, doxycycline, and metronidazole targets the most common causative organisms including Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobes.
- For patients with severe infection or who are pregnant, hospitalization and IV antibiotics may be necessary.
- Alternative regimens for patients with allergies include clindamycin plus gentamicin.
- After treatment, patients should be reassessed within 48-72 hours to ensure clinical improvement.
- A new IUD can generally be inserted after complete resolution of the infection, typically after completing the full course of antibiotics. Prevention strategies include proper insertion technique and screening for sexually transmitted infections prior to IUD placement, with prophylactic antibiotics not being routinely recommended due to limited benefit in reducing IUD-related complications, as shown in studies 2, 3, 4, 5.