Pelvic Inflammatory Disease (PID)

National guidance recommends ofloxacin as first line. Ofloxacin is a racemic mixture containing levofloxacin (the S-enantiomer) as the main active molecule and is more potent than ofloxacin.  Levofloxacin is commonly used for other acute infections and is readily available in all community pharmacies and hospital sites.  For this reason, NHS Highland guidance recommends levofloxacin.

  • All patients should be tested for Chlamydia and Gonorrhoea.
  • Testing for Mycoplasma genitalium is recommended, but currently not available outside Sexual Health.
  • Treatment should not be delayed by awaiting results.
  • Patients with severe clinical presentation should be referred for inpatient assessment/treatment.
  • Current partner(s) within the past ~6 months (depending on history) should be tested +/- treated - this can be arranged by referral to Sexual Health.
  • Other things to consider - analgesia for symptomatic relief, pregnancy test, full STI screen including HIV/Syphilis.

For glossary of terms see Glossary

Drug details

First line therapy: 

Ceftriaxone 1g IM

PLUS

Doxycycline 100mg twice daily

PLUS

Metronidazole 400mg twice daily

14 days

Second line therapy:

Levofloxacin 500mg once a day

PLUS 

Metronidazole 400mg twice daily

OR 

Moxifloxacin 400mg once daily

14 days

Severe infection: pyrexia over 38°C, signs of tubo-ovarian absess or pelvic peritonitis. 

IV Ceftriaxone 2 gram once daily
PLUS Doxycycline (oral) 100mg twice daily

THEN Doxycycline 100mg twice daily
PLUS Metronidazole 400mg twice daily

Continue IV therapy for 24 hours after clinical improvement then switch to oral for a total of 14 days. 

Severe infection: if nil by mouth or beta-lactam anaphylaxis.

IV Clindamycin 900mg 3 times daily
PLUS IV Gentamicin dose as per NHS Highland gentamicin guidelines

THEN Doxycycline 100mg twice daily
PLUS Metronidazole 400mg twice daily

Continue IV therapy for 24 hours after clinical improvement then switch to oral for a total of 14 days. 

Last reviewed: 27 April 2022

Next review: 27 April 2025

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT128