Pelvic inflammatory disease

Antimicrobial prescribing: NHS Lothian
NHS Lothian

For full guidance see Pelvic Inflammatory Disease (PID) Guidance, Gynaecology Services Lothian (intranet only)

In pregnant or breast feeding see: Pelvic inflammatory disease in pregnancy

 

Required investigations

STI testing page:

  • Vaginal swab for combined Chlamydia/Gonorrhoea NAAT test.
  • Consider high vaginal swab.
  • Consider HIV and syphilis testing.

Blood cultures are required for patients admitted to hospital for IV therapies

Recommended antimicrobials for outpatients

Recommended total duration: 14 days

Doxycycline 100mg orally every 12 hours 

 AND 

Metronidazole 400mg orally every 12 hours 

If a high risk of gonorrhoea

Ceftriaxone 1000mg IM single dose

AND

Doxycycline 100mg orally every 12 hours 

AND 

Metronidazole 400mg orally every 12 hours 

Ceftriaxone is associated with C.difficile diarrhoea.

Recommended antimicrobial for inpatients

Recommended total duration: 14 days

Recommended antibiotics

Ceftriaxone 2g IV daily

STOP when temperature <38oC for >24 hours and evidence of improvement of signs of sepsis, if present on admission (single dose treatment acceptable).

AND

Doxycycline 100mg orally every 12 hours

AND

Metronidazole 400mg orally every 12 hours

Alternative in anaphylaxis to penicillin or cephalosporin allergy

OR unable to tolerate oral medication

OR doxycyline contraindicated

Ciprofloxacin 400mg IV every 12 hours

AND

Metronidazole 500mg IV every 8 hours

If signs of sepsis with organ dysfunction.

ADD

Vancomycin IV as per NHS Lothian AMT intranet calculator.

See MHRA warning related to ciprofloxacin.

Ciprofloxacin and ceftriaxone are associated with C.difficile diarrhoea.

IV to oral switch options

Doxycycline 100mg every 12 hours

AND

Metronidazole 400mg every 12 hours

Where doxycycline is contraindicated

Ofloxacin 400mg every 12 hours

AND

Metronidazole 400mg every 12 hours

See MHRA warning related to ofloxacin.

Ofloxacin is associated with C.difficile diarrhoea.

Notes

Likely organisms: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, anaerobes