What antibiotics (abx) could possibly cover both Pelvic Inflammatory Disease (PID) and Urinary Tract Infection (UTI)?

From the Guidelines

For treating both Pelvic Inflammatory Disease (PID) and Urinary Tract Infection (UTI) simultaneously, a combination of ceftriaxone and doxycycline is the most appropriate regimen, as it covers a broad spectrum of pathogens, including Neisseria gonorrhoeae, Chlamydia trachomatis, and gram-negative bacteria like E. coli, as suggested by the most recent guidelines 1. When considering the treatment of both PID and UTI, it's crucial to select antibiotics that effectively target the common causative organisms of both conditions.

• Ceftriaxone, a third-generation cephalosporin, is effective against Neisseria gonorrhoeae and other gram-negative bacteria, making it a suitable choice for PID and UTI treatment, as indicated in the European Association of Urology guidelines 1.
• Doxycycline, a tetracycline antibiotic, is effective against Chlamydia trachomatis, a common cause of PID, and is also active against a range of other bacteria that can cause UTIs, as shown in the guidelines 1. The combination of ceftriaxone and doxycycline provides broad-spectrum coverage, addressing the complex microbial etiology of both PID and UTI.
• This regimen is supported by the most recent and highest quality evidence, which prioritizes the use of broad-spectrum antibiotics in the treatment of PID and UTI, as seen in the 2024 European Association of Urology guidelines 1. It's essential to note that antibiotic selection should ideally be guided by culture results when available, and treatment should begin promptly to prevent complications such as infertility from PID or kidney infection from UTI, as emphasized in the guidelines 1.
• Patients should complete the full course of antibiotics even if symptoms improve before completion, to ensure eradication of the infection and prevent the development of antibiotic resistance, as recommended in the guidelines 1.

From the FDA Drug Label

14.7 Complicated Urinary Tract Infections and Acute Pyelonephritis: 5 Day Treatment Regimen To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I. V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I. V. or 500 mg orally twice daily for 10 days (563 patients).

The antibiotics that could possibly cover both Pelvic Inflammatory Disease (PID) and Urinary Tract Infection (UTI) are:

• Levofloxacin However, the provided label does not directly address the use of levofloxacin for PID. For UTI, levofloxacin has been shown to be effective in clinical trials 2. No conclusion can be drawn regarding the use of levofloxacin for PID based on the provided label.

From the Research

Antibiotics for PID and UTI

To cover both Pelvic Inflammatory Disease (PID) and Urinary Tract Infection (UTI), the following antibiotics could be considered:

• Ceftriaxone, a third-generation cephalosporin, which has been shown to be effective against Neisseria gonorrhoeae and Enterobacteriaceae 3, 4
• Doxycycline, a tetracycline antibiotic, which is effective against Chlamydia trachomatis 3, 5, 6
• Metronidazole, which provides coverage against anaerobic organisms 7, 5, 6
• Ciprofloxacin, a fluoroquinolone antibiotic, which has been shown to be effective against a broad range of bacteria, including those causing PID and UTI 5

Combination Therapies

Combination therapies, such as ceftriaxone and doxycycline, with or without metronidazole, have been studied and shown to be effective in treating PID 3, 7

• The addition of metronidazole to ceftriaxone and doxycycline has been shown to reduce endometrial anaerobes, decrease M. genitalium, and reduce pelvic tenderness in women with acute PID 7
• Ciprofloxacin has been compared to doxycycline and metronidazole in the treatment of PID, and has been shown to have a higher success rate 5

UTI Treatment

For UTI, single-dose ceftriaxone treatment has been compared to a standard five-day regimen of trimethoprim-sulfamethoxazole, and has been shown to have a similar cure rate 4