Pelvic Inflammatory Disease- Antibiotic Management, Severe Disease

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. Ceftriaxone is now the standard treatment for infections where sensitivity results are unknown.

IV therapy for severe disease:

Ceftriaxone 1g od IV

plus Metronidazole 500 mg tds IV

plus Doxycycline 100mg bd PO (or Clarithromycin 500 mg bd IV if unable to take oral medication)

Change to oral Doxycycline 100mg bd PO plus Metronidazole 400mg tds PO to complete 14 days total treatment when clinically improved for 24 hours (further doses of ceftriaxone are not required).

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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