Pelvic Inflammatory Disease (PID)

All patients should be tested for Chlamydia and Gonorrhoea prior to treatment initiation with NAAT/PCR vaginal swab.
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.

First line therapy:

Ceftriaxone 1g IM single dose

PLUS Doxycycline 100mg twice daily

PLUS Metronidazole 400mg twice daily

14 days

Second line therapy:

Levofloxacin 500mg once a day (see BNF warnings and MHRA Drug Safety Alert)

PLUS Metronidazole 400mg twice daily

OR Moxifloxacin 400mg once daily (see BNF warnings and MHRA Drug Safety Alert)

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 February 2023

Next review: 27 February 2026

Author(s): Antimicrobial Management Team

Approved By: TAM Subgroup of ADTC

Reviewer Name(s): Area Antimicrobial Pharmacist

Document Id: AMT128