Pelvic Inflammatory Disease- Antibiotic Management

Inform Registrar who will review the patient after admission (preferably before initiating treatment).

Both locally and nationally, resistance in gonococcal isolates has meant that both the penicillin and quinolone antibiotics can no longer be relied upon for empirical treatment of gonococcal disease. Intramuscular ceftriaxone is now the standard treatment for infections where sensitivity results are unknown.

1st line antibiotics for pelvic inflammatory disease:

Ceftriaxone 250mg IM stat (for gonococcal cover) (if IM route contraindicated - Ceftriaxone 1g IV or cefixime 400mg PO stat)

plus Doxycycline 100mg bd for 14 days and Metronidazole 400 mg bd PO for 5 days

If pregnant click here

If vomiting and unable to take oral treatment click here

IV therapy for severe disease is indicated if :

• A surgical emergency cannot be excluded

• Lack of response to oral therapy

• Clinically severe disease (temp >38^oC, signs of pelvic peritonitis, signs of a tubo-ovarian abscess)

• Intolerance to oral therapy

• Disseminated Gonococcal infection.

For severe disease and IV therapy click here

Adjust antibiotics according to culture and sensitivity results only if no improvement, and after discussion with microbiology (in view of rising resistance in Gonococcal isolates)

The Full Guideline "Antibiotic Guideline for Acute Pelvic Inflammatory Disease" is available here.

Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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