Treatment of Pelvic Inflammatory Disease in Australia
For pelvic inflammatory disease (PID) in Australia, the recommended treatment is a broad-spectrum antibiotic regimen that covers Chlamydia trachomatis, Neisseria gonorrhoeae, anaerobes, gram-negative rods, and streptococci. 1, 2
Hospitalization Criteria
Patients should be hospitalized for PID treatment if they meet any of the following criteria:
- Uncertain diagnosis or inability to exclude surgical emergencies 2
- Suspected pelvic abscess 2
- Pregnancy 2
- Adolescent patient 2
- Severe illness 2
- Inability to tolerate oral medication 2
- Failure to respond to outpatient treatment 2
- Inability for follow-up within 72 hours of starting antibiotics 2
Inpatient Treatment Regimens
Recommended Regimen A:
- Cefoxitin 2 g IV every 6 hours OR cefotetan 2 g IV every 12 hours 1, 2
- PLUS Doxycycline 100 mg orally or IV every 12 hours 1, 2
- Continue for at least 48 hours after clinical improvement 1, 2
- After discharge, continue doxycycline 100 mg orally twice daily to complete 10-14 days of treatment 1, 2
Recommended Regimen B:
- Clindamycin 900 mg IV every 8 hours 1, 2
- PLUS Gentamicin loading dose IV or IM (2 mg/kg body weight) followed by maintenance dose (1.5 mg/kg) every 8 hours 1, 2
- Continue for at least 48 hours after clinical improvement 1, 2
- After discharge, continue doxycycline 100 mg orally twice daily for 10-14 days total 1, 2
- Alternative post-discharge: clindamycin 450 mg orally four times daily for 10-14 days 1, 2
Outpatient Treatment for Mild to Moderate PID
- Cefoxitin 2 g IM plus probenecid 1 g orally simultaneously 2
- OR Ceftriaxone 250 mg IM 2, 3
- PLUS Doxycycline 100 mg orally twice daily for 10-14 days 2, 4
Treatment Considerations
Antimicrobial Coverage
- PID is a polymicrobial infection requiring broad-spectrum coverage 1, 5
- Common pathogens include C. trachomatis, N. gonorrhoeae, M. genitalium, and bacterial vaginosis-associated anaerobes 5, 4
- Cefoxitin and ceftriaxone provide excellent coverage for N. gonorrhoeae, including penicillinase-producing strains 3, 6
- Doxycycline is the treatment of choice for C. trachomatis infection 1, 2
- Clindamycin provides more complete anaerobic coverage than doxycycline 1, 2
Clinical Efficacy
- Both cefoxitin/doxycycline and clindamycin/aminoglycoside combinations have demonstrated high clinical cure rates 1, 7
- The overall favorable response rate to combination antimicrobial therapy is approximately 98.5% in uncomplicated PID and 81% in PID complicated by tubo-ovarian abscess 7
Potential Complications
- Even with appropriate treatment, PID can result in long-term sequelae including infertility, ectopic pregnancy, and chronic pelvic pain 5, 8
- Tubo-ovarian abscesses may require additional interventions such as percutaneous drainage if not responding to antibiotic therapy 8
- Surgical intervention may be necessary in cases of intractable PID or complicated tubo-ovarian abscesses 7