Pelvic inflammatory disease

A low threshold for empirical treatment of PID is recommended because of the lack of definitive clinical diagnostic criteria and because the potential consequences of not treating of PID are significant.

The following clinical features are suggestive of a diagnosis of PID:

  • bilateral lower abdominal tenderness (sometimes radiating to the legs)
  • abnormal vaginal or cervical discharge
  • fever (greater than 38°C)
  • abnormal vaginal bleeding (intermenstrual, postcoital or 'breakthrough')
  • deep dyspareunia
  • cervical motion tenderness on bimanual vaginal examination
  • adnexal tenderness on bimanual vaginal examination (with or without a palpable mass).

Click here for the trust guideline

Severity
(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A

Minor infection

Review doses in renal impairment

CEFTRIAXONE 500mg im stat
Followed by:
DOXYCYCLINE 100mg po bd
plus
METRONIDAZOLE 400mg po bd

Duration: 14 days 

AZITHROMYCIN 1g po stat
Followed by:
OFLOXACIN 400mg po bd
plus
METRONIDAZOLE 400mg po bd

Duration: 14 days 

Intravenous therapy is recommended for patients with more severe clinical disease e.g. pyrexia >38°C, clinical signs of tubo-ovarian abscess, signs of pelvic peritonitis.

Intravenous therapy should be continued until 24 hours after clinical improvement and then switched to oral.

B/C

Severe life threatening infection

Review doses in renal impairment

CEFTRIAXONE 2g iv od
plus
DOXYCYCLINE 100mg po bd
plus
METRONIDAZOLE 500mg iv tds (or 400mg po tds if oral antibiotics tolerated and patient absorbing)

AZITHROMYCIN 1g po stat
followed by:
CLINDAMYCIN 900mg iv tds
plus
GENTAMICIN iv (as per local protocol)

IV to Oral Switch
(explanatory notes)

DOXYCYCLINE 100mg po bd
plus
METRONIDAZOLE 400mg po bd

To complete 14 days

CLINDAMYCIN 450mg po qds
plus
OFLOXACIN 400mg po bd

To complete 14 days

Last reviewed: 16/04/15

 For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)