Health Library Antibiotics for Pelvic Inflammatory DiseaseFrom Healthwise

Pelvic inflammatory disease (PID) is often caused by a combination of different types of bacteria, so a combination (regimen) of medicines is used to treat the infection. Treatment changes as new medicines are developed or as the bacteria that cause the infection become resistant to old medicines. Treatment guidelines from the U.S. Centers for Disease Control and Prevention recommend one of the following regimens:¹

Outpatient treatment options

Ceftriaxone plus doxycycline with or without metronidazole

Ceftriaxone is given one time as an injection in a muscle. Doxycycline is taken as pills twice a day usually for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline. Metronidazole is taken as pills twice a day usually for 14 days. Do not drink alcohol when taking metronidazole. The number of days you continue to take antibiotics depends on your illness and the type of antibiotic medicine.

Cefoxitin with probenecid plus doxycycline with or without metronidazole

Cefoxitin is given one time as an injection in a muscle. Probenecid is taken as a pill in a single dose at the time of the shot. Doxycycline is taken as pills twice a day usually for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline. Metronidazole is taken as pills twice a day usually for 14 days. Do not drink alcohol when taking metronidazole. The number of days you continue to take antibiotics depends on your illness and the type of antibiotic medicine.

Other antibiotic medicines are sometimes used for treating PID.

Inpatient treatment options

Some women need to be hospitalized for pelvic inflammatory disease treatment. In the hospital, antibiotics are first given through a vein (intravenous, or IV) for at least 24 hours, followed by antibiotics by mouth, which are continued at home after discharge from the hospital. Total treatment with medicine usually lasts for 14 days.²

· Inpatient intravenous, regimen A

Cefotetan

Cefotetan is given intravenously every 12 hours.

OR:

Cefoxitin plus doxycycline

Cefoxitin is given intravenously every 6 hours. Doxycycline is given intravenously or in pill form every 12 hours.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline or clindamycin) are given.

· Inpatient intravenous, regimen B

Clindamycin is given intravenously every 8 hours. Gentamicin is given intravenously or by injection every 8 hours or once a day.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline and/or clindamycin) are given.

· Alternative intravenous regimen

Ampicillin/sulbactam plus doxycycline

Ampicillin/sulbactam is given intravenously every 6 hours. Doxycycline is given intravenously or in pill form every 12 hours

Antibiotics kill the various bacteria that cause PID.

Antibiotics are used if you have one or more signs of PID and you are at risk for PID.

• There is recent onset of lower pelvic tenderness or pain, especially if it is on both sides.
• There is recent onset of pain or tenderness when the fallopian tubes or ovaries are touched or moved during examination.
• There is pain or tenderness when the cervix is moved during examination.

Not all women who have PID will have pelvic pain. This is why many experts say that women should be treated for PID if they are at risk for PID and have pain when the cervix is moved, especially if there is an abnormal cervical discharge.

Antibiotic treatment kills the bacteria causing PID. The risks of a future tubal pregnancy (ectopic pregnancy), ongoing (chronic) pelvic pain, and infertility are less if you start treatment early.

The common side effects of the antibiotics recommended for PID include:

• Nausea or vomiting.
• Diarrhea.
• Rash.
• Headache.
• Fatigue.
• Dizziness.
• Yeast infection.

Each antibiotic medicine for PID may have specific side effects or interactions with other medicines.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

If side effects from the medicine occur, report them to your doctor. He or she may prescribe other antibiotics that cause fewer side effects.

Antibiotics can prevent PID complications when the medicine is started early and when all the medicine is taken.

Tell your doctor if you think you might be pregnant. Some antibiotics are not recommended during pregnancy.

A follow-up exam should be performed 2 to 3 days after you start treatment. You will likely have less pain and tenderness during an abdominal and pelvic exam. Follow-up exams at 7 to 10 days and 4 to 6 weeks are usually recommended to make sure treatment is successful.

If your symptoms have not improved, your doctor may try another medicine regimen or look for other possible causes of your symptoms, including ectopic pregnancy, appendicitis, pelvic abscess, or endometriosis.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

Citations

1. Centers for Disease Control and Prevention (2006, updated 2007). Pelvic inflammatory disease section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 56–61.
2. American Academy of Pediatrics (2006). Pelvic inflammatory disease. In LK Pickering et al., eds., Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed., pp. 493–498. Elk Grove Village, IL: American Academy of Pediatrics.

Author:	Sandy Jocoy, RN	Last Updated: November 26, 2008
Medical Review:	Sarah Anne Marshall, MD - Family Medicine Kirtly Jones, MD - Obstetrics and Gynecology
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