Pelvic Inflammatory Disease
- A complete sexual history is imperative
- If sexually transmitted infection is considered, contact Oxford Sexual Health Service (01865 231231) department for notification, screening and contact tracing advice.
- Send cervical / vaginal swabs, rectal swabs and throat swabs for screening of chlamydia and Gonorrhoea. Use EPR ‘PID/STD/Gonorrhoea/Chlamydia/Trichomonas PCR genital samples’ Careset
- Screen for HIV and syphilis (inform patient)
- For in-patients, consult Micro/ID
- Pregnancy testing (bHCG on urine) is indicated
- Metronidazole is usually used for 14 days as per BASHH. Metronidazole is included in some regimens to improve coverage for anaerobic bacteria. Anaerobes are of relatively greater importance in patients with severe PID and metronidazole may be discontinued after 5 days in those patients with mild or moderate PID who are unable to tolerate it. Please contact sexual health if further advice and guidance are required.
Non-pregnant cases: Out-patients
Preferred
ceftriaxone 1g IM single dose PLUS doxycycline 100mg po bd PLUS metronidazole 400mg po bd, both oral antibiotics for 14 days.
Alternative
ceftriaxone 1g IM single dose PLUS azithromycin 1g po once a week PLUS metronidazole 400mg po bd, both oral antibiotics for 14 days.
Third line: Discuss with GUM or Micro/ID
Non-pregnant cases: In-patients
Aim for early oral switch.
Preferred
ceftriaxone 2 g iv od PLUS doxycycline 100mg po bd (iv only if NBM) PLUS metronidazole 400mg po bd
Followed by: doxycycline 100mg po bd PLUS metronidazole 400mg po bd, both to complete 14 days course.
Severe penicillin allergy
Consider penicillin allergy assessment and delabelling
clindamycin 900mg iv tds PLUS metronidazole 400mg po bd PLUS gentamicin* 5mg/kg iv (Gentamicin is for maximum of 3 days).
*Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.
Followed by: doxycycline 100mg po bd PLUS metronidazole 400mg po bd, both to complete 14 days course.
Pregnant cases
ceftriaxone 2 g IV single dose (or if an out-patient: 1g IM) PLUS erythromycin 500mg po qds PLUS metronidazole 400mg po bd, both oral antibiotics for 14 days.
Reference
BASHH. Pelvic Inflammatory Disease Guidelines (2019) Accessed here Guidelines | British Association for Sexual Health and HIV (bashh.org)