From the Guidelines
For outpatient treatment of pelvic inflammatory disease (PID), the recommended regimen includes ceftriaxone 250 mg intramuscularly as a single dose, plus doxycycline 100 mg orally twice a day for 14 days, with or without metronidazole 500 mg orally twice a day for 14 days. The choice of ceftriaxone is based on its effectiveness against Neisseria gonorrhoeae, as recommended by the Centers for Disease Control and Prevention in their 2002 guidelines 1. The dose of ceftriaxone is specified as 250 mg IM in a single dose, which is the recommended dose for outpatient treatment of PID 1. Doxycycline is added to target Chlamydia trachomatis, and metronidazole may be included to cover anaerobic bacteria. Key points to consider in outpatient treatment of PID include:
- Completing the full 14-day course of oral antibiotics even if symptoms improve earlier
- Advising patients to abstain from sexual intercourse until treatment is completed and symptoms have resolved
- Scheduling a clinical reassessment within 72 hours if symptoms don't improve or worsen
- Evaluating and treating partners from the past 60 days empirically
- Considering hospitalization for intravenous antibiotics if the patient has severe symptoms, allergies to these medications, or fails to respond to treatment.
From the Research
PID Outpatient Treatment
- Ceftriaxone and doxycycline are commonly used for the treatment of pelvic inflammatory disease (PID) in an outpatient setting 2.
- The recommended treatment for mild to moderate PID is a single intramuscular injection of ceftriaxone followed by oral doxycycline for 14 days 2.
- Metronidazole is also recommended for 14 days in the setting of bacterial vaginosis, trichomoniasis, or recent uterine instrumentation 2.
Ceftriaxone and Doxycycline Dose
- The dose of ceftriaxone is typically 250 mg intramuscularly as a single dose 3, 4.
- The dose of doxycycline is typically 100 mg orally twice a day for 14 days 2, 3.
Addition of Metronidazole
- The addition of metronidazole to ceftriaxone and doxycycline has been shown to be effective in reducing endometrial anaerobes, decreasing M. genitalium, and reducing pelvic tenderness 3.
- Metronidazole should be routinely added to ceftriaxone and doxycycline for the treatment of women with acute PID 3.
Alternative Treatment Regimens
- A short-course azithromycin-based regimen has been shown to be less effective than the standard treatment with ofloxacin plus metronidazole 5.
- The use of ceftriaxone, doxycycline, and metronidazole has been shown to be more effective than doxycycline and metronidazole alone in the treatment of PID 4.