Pelvic Inflammatory Disease (PID) (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
- All patients should be tested for Chlamydia and Gonorrhoea prior to treatment initiation with NAAT/PCR vaginal swab.
- Testing for Mycoplasma genitalium is recommended, but currently not available outside Sexual Health.
- Treatment should not be delayed by awaiting results.
- Patients with severe clinical presentation should be referred for inpatient assessment/treatment.
- Current partner(s) within the past ~6 months (depending on history) should be tested +/- treated - this can be arranged by referral to Sexual Health.
- Other things to consider - analgesia for symptomatic relief, pregnancy test, full STI screen including HIV/Syphilis.
Patient information is available here: https://highlandsexualhealth.co.uk/stis/pid.
For glossary of terms see Glossary.
Drug details
First line therapy
Ceftriaxone 1g IM single dose
PLUS Doxycycline 100mg twice daily
PLUS Metronidazole 400mg twice daily
14 days
Second line therapy
Levofloxacin 500mg once a day (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
PLUS Metronidazole 400mg twice daily
OR Moxifloxacin 400mg once daily (see BNF warnings and MHRA Drug Safety Alert (updated 22 January 2024))
14 days
Severe infection: pyrexia over 38°C, signs of tubo-ovarian absess or pelvic peritonitis.
IV Ceftriaxone 2 gram once daily
PLUS Doxycycline (oral) 100mg twice daily
THEN Doxycycline 100mg twice daily
PLUS Metronidazole 400mg twice daily
Continue IV therapy for 24 hours after clinical improvement then switch to oral for a total of 14 days.
Severe infection: if nil by mouth or beta-lactam anaphylaxis.
IV Clindamycin 900mg 3 times daily
PLUS IV Gentamicin dose as per NHS Highland gentamicin guidelines
THEN Doxycycline 100mg twice daily
PLUS Metronidazole 400mg twice daily
Continue IV therapy for 24 hours after clinical improvement then switch to oral for a total of 14 days.