Genital Tract Infection

Pelvic Inflammatory Disease (PID)

General points

• Check pregnancy test.
• Send HVS for culture and full STI screen: Gonorrhoea, Chlamydia, Syphilis, HIV, Hepatitis B & C and Mycoplasma genitalium.
• Refer to most recent BASHH Guidelines.
• Further information is available on HSE Antibiotic Prescribing. https://www.hse.ie/eng/services/list/2/gp/antibiotic-prescribing/conditions-and-treatments/genital/pelvic-inflammatory-disease/pelvic-inflammatory-disease-pid-.html

Antibiotics

Outpatient Rx:

Ceftriaxone 1g IM or IV single dose + Doxycycline PO 100 mg BD + Metronidazole PO 400mg TDS x 14 days.

Inpatient Rx:

Ceftriaxone 2g once daily IV + Doxycycline 100mg BD PO.

Oral switch Doxycycline 100mg BD PO + Metronidazole PO 400mg TDS x 14 days.

IV Ceftriaxone therapy should be continued until 24 hours after clinical improvement then switched to oral.

Severe / IgE mediated reaction/ anaphylaxis to penicillin:

Clindamycin 900mg TDS IV+ Gentamicin once daily IV. (Please see Gentamicin dosing schedule).

Oral switch: Clindamycin 450mg QDS PO or Doxycycline 100mg BD PO + Metronidazole 400mg BD PO to complete 14 days.

Comments

Duration : 14 days

Note: Ofloxacin and moxifloxacin should be avoided in patients who are at high risk of gonococcal PID because of increasing quinolone resistance .

In pregnancy: IV therapy and specialist consultation is advised.