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 for 5-7 days is local practice. If the patient requires longer course speak to Micro/ID.
Non-pregnant cases: Out-patients
Preferred
ceftriaxone 1g IM single dose PLUS doxycycline 100mg po bd for 14 days PLUS metronidazole 400mg po bd (5-7 days metronidazole is usually enough)
Alternative
ceftriaxone 1g IM single dose PLUS azithromycin 1g po once a week for 2 weeks PLUS metronidazole 400mg po bd (5-7 days metronidazole is usually enough)
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 to complete 14 days course PLUS metronidazole 400mg po bd (5-7 days metronidazole is usually enough)
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 to complete 14 days course PLUS metronidazole 400mg po bd (5-7 days metronidazole is usually enough)
Pregnant cases
ceftriaxone 2 g IV single dose (or if an out-patient: 1g IM) PLUS erythromycin 500mg po qds for 14 days PLUS metronidazole 400mg po bd (5-7 days metronidazole is usually enough)
Reference
BASHH. Pelvic Inflammatory Disease Guidelines (2019) Accessed here Guidelines | British Association for Sexual Health and HIV (bashh.org)