Pelvic Inflammatory Disease Organism-Specific Therapy 

Updated: Jan 24, 2019
Author: Ritu Kumar, MD; Chief Editor: Michael Stuart Bronze, MD 

Specific Organisms and Therapeutic Regimens

All drug regimens used to treat pelvic inflammatory disease (PID) should be effective against Neisseria gonorrhoeae and Chlamydia trachomatis.[1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15]

There is no agreement amongst experts on whether treatment of pelvic inflammatory disease should include anaerobic coverage. Outpatient regimens provided below have moderate coverage, while inpatient regimens have excellent coverage. Some experts recommend that all women should be covered for anaerobes, while others recommend that only women with severe disease requiring hospitalization, or those with tubo-ovarian abscesses should be covered. 

C trachomatis

See the list below:

  • Doxycycline 100 mg IV or PO q12h for 14d or

  • Azithromycin 500 mg IV for 1-2 doses, followed by 250 mg PO for 5-6d

N gonorrhoeae

See the list below:

  • Uncomplicated gonorrhea[5] : Ceftriaxone 250 mg IM plus either azithromycin 1 g PO as a single dose or doxycycline 100 mg PO q12h for 7d or

  • Ceftriaxone 1 g IV q24h or

  • Cefoxitin 2 g IV q6h or

  • Cefotetan 2 g IV q12h

  • If N gonorrhoeae is the suspected pathogen, fluoroquinolones are no longer recommended secondary to increased resistance

  • Cefixime is no longer recommended at any dose as first-line treatment of gonococcal infections[4, 5] ; if used as an alternative agent, cefixime 400 mg PO plus either azithromycin 1 g PO as a single dose or doxycycline 100 mg PO q12h × 7 days (Patients should return in 1 week for a test-of-cure at the infection site.)[5]

Bacteroides fragilis

See the list below:

  • Cefoxitin 2 g IV q6h or

  • Cefotetan 2 g IV q12h or

  • Metronidazole 500 mg PO q12h or

  • Ampicillin-sulbactam 3 g IV q6h

Enterobacteriaceae

See the list below:

  • Cefoxitin 2 g IV q6h or

  • Cefotetan 2 g IV q12h or

  • Gentamicin IV or IM 2 mg/kg loading dose, followed by 1.5 mg/kg q8h maintenance dose