Template:PID antibiotics: Difference between revisions
(Add AntibioticDose entries: Azithromycin)
 
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===Antibiotics===
===Antibiotics===
*No sexual activity for 2 weeks;  
*No sexual activity for 2 weeks;
*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 Antibiotic 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>
*{{AntibioticDose|disease=Pelvic inflammatory disease|drug=Ceftriaxone|dose=500mg IM x1 (1g if >150kg)|context=Outpatient; combined with Doxycycline and Metronidazole}}<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> + {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Doxycycline|dose=100mg PO BID x 14 days|context=Outpatient}} + {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Metronidazole|dose=500mg PO BID x 14 days|context=Outpatient; recommended empirically by CDC and European guidelines}}<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><ref>Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1-187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon</ref>
**[[Metronidazole]]
*{{AntibioticDose|disease=Pelvic inflammatory disease|drug=Cefoxitin|dose=2g IM x1 plus Probenecid 1g PO|context=Outpatient alternative}}<ref>CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm</ref> + [[Doxycycline]] 100mg PO BID x 14 days + [[metronidazole]]
***Recommended empirically by European guidelines <ref>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.</ref>
***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
*[[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=====
*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
**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 Antibiotic Options ====
==== Inpatient Antibiotic Options ====
*[[Cefoxitin]] 2gm IV q6hr OR [[cefotetan]] 2gm IV q12hr) + [[doxycycline]] PO or IV 100 mg q12hr OR
*Recommended<ref>Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1-187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon</ref>: {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Ceftriaxone|dose=1g IV q24hr|context=Inpatient; combined with Doxycycline and Metronidazole}} OR {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Cefoxitin|dose=2g IV q6hr|context=Inpatient}} OR {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Cefotetan|dose=2g IV q12hr|context=Inpatient}} + {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Doxycycline|dose=100mg PO or IV q12hr|context=Inpatient}} + {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Metronidazole|dose=500mg IV or PO q12hr|context=Inpatient}} OR
*[[Clindamycin]] 900mg IV q8h + [[gentamicin]] 2mg/kg QD OR
*{{AntibioticDose|disease=Pelvic inflammatory disease|drug=Clindamycin|dose=900mg IV q8hr|context=Inpatient alternative; combined with Gentamicin}} + {{AntibioticDose|disease=Pelvic inflammatory disease|drug=Gentamicin|dose=2mg/kg loading then 1.5mg/kg q8hr IV|context=Inpatient; combined with Clindamycin}} OR
*[[Ampicillin-sulbactam]] 3gm IV q6hr + [[doxycycline]] 100mg IV/PO q12hr
*{{AntibioticDose|disease=Pelvic inflammatory disease|drug=Ampicillin/Sulbactam|dose=3g IV q6hr|context=Inpatient alternative; combined with Doxycycline}} + [[doxycycline]] 100mg IV/PO q12hr
*{{AntibioticDose|drug=Azithromycin|dose=500mg IV q24h x1-2 days, then 250mg PO q24h x5-6 days|context=PID|disease=Pelvic inflammatory disease|population=Adult}}

Latest revision as of 10:54, 20 March 2026

Antibiotics

  • 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

Inpatient Antibiotic Options

  1. ↑ 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.
  2. ↑ Update to CDC's Treatment Guidelines for Gonococcal Infection, 2020 https://www.cdc.gov/mmwr/volumes/69/wr/mm6950a6.htm
  3. ↑ 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
  4. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1-187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
  5. ↑ CDC PID Treatment http://www.cdc.gov/std/treatment/2010/pid.htm
  6. ↑ Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021;70(No. RR-4):1-187. DOI: http://dx.doi.org/10.15585/mmwr.rr7004a1external icon
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