Template:PID antibiotics: Difference between revisions
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;Treat all partners who had sex with patient during previous 60 days prior to symptom onset | ;Treat all partners who had sex with patient during previous 60 days prior to symptom onset | ||
=== Outpatient Options === | === Outpatient Antibiotic Options === | ||
*[[Ceftriaxone]] 500mg IM (or IV)<ref>Hayes BD. Trick of the Trade: IV ceftriaxone for gonorrhea. October 9th, 2012 ALiEM. https://www.aliem.com/2012/10/trick-of-trade-iv-ceftriaxone-for/. Accessed October 23, 2018.</ref><ref>Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm</ref> x1 + [[doxycycline]] 100mg PO BID x14d +/- [[metronidazole]] 500mg PO BID x14d <ref>Ness RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–37</ref> | *[[Ceftriaxone]] 500mg IM (or IV)<ref>Hayes BD. Trick of the Trade: IV ceftriaxone for gonorrhea. October 9th, 2012 ALiEM. https://www.aliem.com/2012/10/trick-of-trade-iv-ceftriaxone-for/. Accessed October 23, 2018.</ref><ref>Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm</ref> x1 + [[doxycycline]] 100mg PO BID x14d +/- [[metronidazole]] 500mg PO BID x14d <ref>Ness RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–37</ref> | ||
**[[Metronidazole]] | **[[Metronidazole]] | ||
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*[[Cefoxitin]] 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose<ref>CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm</ref> + [[Doxycycline]] 100 mg PO BID x 14 days +/- [[flagyl]] based on above criteria | *[[Cefoxitin]] 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose<ref>CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm</ref> + [[Doxycycline]] 100 mg PO BID x 14 days +/- [[flagyl]] based on above criteria | ||
====Discontinued | ====Discontinued==== | ||
*Historically the following regimens were acceptable but with the emerging resistance patterns use the following with caution.<ref>Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm </ref> | *Historically the following regimens were acceptable but with the emerging resistance patterns use the following with caution.<ref>Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm </ref> | ||
*[[Ceftriaxone]] 250mg IM x1 + 1 g of [[azithromycin]] per week, x 2 weeks<ref name="Savaris">Savaris RF. et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007 Jul;110(1):53-60</ref> +/- [[metronidazole]] based on above criteria | *[[Ceftriaxone]] 250mg IM x1 + 1 g of [[azithromycin]] per week, x 2 weeks<ref name="Savaris">Savaris RF. et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007 Jul;110(1):53-60</ref> +/- [[metronidazole]] based on above criteria | ||
**A single randomized controlled trial shows that [[azithromycin]] is superior to [[doxycycline]] even when compliance in taking doxycycline is excellent (98.2% vs 87.5%)<ref name="Savaris"></ref> | **A single randomized controlled trial shows that [[azithromycin]] is superior to [[doxycycline]] even when compliance in taking doxycycline is excellent (98.2% vs 87.5%)<ref name="Savaris"></ref> | ||
=== Inpatient === | === Inpatient Antibiotic Options === | ||
*[[Cefoxitin]] 2gm IV q6hr OR [[cefotetan]] 2gm IV q12hr) + [[doxycycline]] PO or IV 100 mg q12hr OR | *[[Cefoxitin]] 2gm IV q6hr OR [[cefotetan]] 2gm IV q12hr) + [[doxycycline]] PO or IV 100 mg q12hr OR | ||
*[[Clindamycin]] 900mg IV q8h + [[gentamicin]] 2mg/kg QD OR | *[[Clindamycin]] 900mg IV q8h + [[gentamicin]] 2mg/kg QD OR | ||
*[[Ampicillin-sulbactam]] 3gm IV q6hr + [[doxycycline]] 100mg IV/PO q12hr | *[[Ampicillin-sulbactam]] 3gm IV q6hr + [[doxycycline]] 100mg IV/PO q12hr | ||
Revision as of 16:42, 27 May 2021
- No sexual activity for 2 weeks;
- Treat all partners who had sex with patient during previous 60 days prior to symptom onset
Outpatient Antibiotic Options
- Ceftriaxone 500mg IM (or IV)[1][2] x1 + doxycycline 100mg PO BID x14d +/- metronidazole 500mg PO BID x14d [3]
- Metronidazole
- Recommended empirically by European guidelines [4]
- American guidelines based upon assessment of risk for anaerobes; consider in:
- Pelvic abscess
- Proven or suspected infection w/ Trichomonas or Bacterial Vaginosis
- History of gynecological instrumentation in the preceding 2-3wks
- Metronidazole
- Cefoxitin 2 g IM in a single dose and Probenecid, 1 g PO administered concurrently in a single dose[5] + Doxycycline 100 mg PO BID x 14 days +/- flagyl based on above criteria
Discontinued
- Historically the following regimens were acceptable but with the emerging resistance patterns use the following with caution.[6]
- Ceftriaxone 250mg IM x1 + 1 g of azithromycin per week, x 2 weeks[7] +/- metronidazole based on above criteria
- A single randomized controlled trial shows that azithromycin is superior to doxycycline even when compliance in taking doxycycline is excellent (98.2% vs 87.5%)[7]
Inpatient Antibiotic Options
- Cefoxitin 2gm IV q6hr OR cefotetan 2gm IV q12hr) + doxycycline PO or IV 100 mg q12hr OR
- Clindamycin 900mg IV q8h + gentamicin 2mg/kg QD OR
- Ampicillin-sulbactam 3gm IV q6hr + doxycycline 100mg IV/PO q12hr
- ↑ Hayes BD. Trick of the Trade: IV ceftriaxone for gonorrhea. October 9th, 2012 ALiEM. https://www.aliem.com/2012/10/trick-of-trade-iv-ceftriaxone-for/. Accessed October 23, 2018.
- ↑ Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
- ↑ Ness RB et al. Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol 2002;186:929–37
- ↑ Ross J, Guaschino S, Cusini M, Jensen J, 2017 European guideline for the management of pelvic inflammatory disease. Int J STD AIDS. 2018 Feb;29(2):108-114. doi: 10.1177/0956462417744099. Epub 2017 Dec 4.
- ↑ CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm
- ↑ Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
- ↑ 7.0 7.1 Savaris RF. et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol. 2007 Jul;110(1):53-60