Antibiotics for pelvic inflammatory disease

Examples

Pelvic inflammatory disease (PID) is often caused by a combination of different types of bacteria, so a combination (regimen) of medications is used to treat the infection. Treatment changes as new medications are developed or as the bacteria that cause the infection become resistant to old medications. Treatment guidelines from the Public Health Agency of Canada (PHAC) recommend one of the following regimens.¹

· Outpatient treatment, regimen A

Ofloxacin or levofloxacin with or without metronidazole

Generic Name	Brand Name
levofloxacin	Levaquin
metronidazole	Flagyl, Trikacide
ofloxacin	Floxin

Ofloxacin is taken as pills twice a day for 14 days. Levofloxacin is taken as pills once a day for 14 days. These medications are not used if you are pregnant. Metronidazole is taken as pills twice a day for 14 days. Do not drink alcohol when taking metronidazole.

· Outpatient treatment, regimen B

One of the following three cephalosporin treatments is used along with doxycycline.

Ceftriaxone plus doxycycline

Generic Name	Brand Name
ceftriaxone	Rocephin
doxycycline	Vibramycin

Ceftriaxone is given one time as an injection in a muscle. Doxycycline is taken as pills twice a day for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline.

OR:

Cefoxitin with probenecid plus doxycycline

Generic Name	Brand Name
cefoxitin
doxycycline	Vibramycin
probenecid	Benuryl

Cefoxitin is given one time as an injection in a muscle. Probenecid is taken as a pill in a single dose at the time of the shot. Doxycycline is taken as pills twice a day for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline.

Other antibiotic medicines are sometimes used for treating PID.

Inpatient treatment

Some women need to be hospitalized for pelvic inflammatory disease treatment. In the hospital, antibiotics are first given through a vein (intravenous, or IV) for at least 24 hours, followed by antibiotics by mouth, which are continued at home after discharge from the hospital. Total medication treatment lasts for 14 days.²

· Inpatient intravenous, regimen A

Cefoxitin plus doxycycline

Generic Name	Brand Name
cefoxitin
doxycycline	Vibramycin

Cefoxitin is given intravenously every 6 hours. Doxycycline is given intravenously or in pill form every 12 hours.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline or clindamycin) are given.

· Inpatient intravenous, regimen B

Generic Name	Brand Name
clindamycin
gentamicin	Garamycin

Clindamycin is given intravenously every 8 hours. Gentamicin is given intravenously or by injection every 8 hours or once a day.

After at least 24 hours of intravenous antibiotics, oral antibiotics (doxycycline or clindamycin) are given.

How It Works

Antibiotics kill the various bacteria that cause PID.

Why It Is Used

Antibiotics are used if you have one or more signs of PID and you are at risk for PID.

• There is recent onset of lower pelvic tenderness or pain, especially if it is on both sides.
• There is recent onset of pain or tenderness when the fallopian tubes or ovaries are touched or moved during examination.
• There is pain or tenderness when the cervix is moved during examination.

Not all women who have PID will have pelvic pain. This is why many experts say that women should be treated for PID if they are at risk for PID and have pain when the cervix is moved, especially if there is an abnormal cervical discharge.

How Well It Works

Antibiotic treatment kills the bacteria causing PID. The risks of a future tubal pregnancy (ectopic pregnancy), ongoing (chronic) pelvic pain, and infertility are less if you start treatment early.

Side Effects

The common side effects of the antibiotics recommended for PID include:

• Nausea or vomiting.
• Diarrhea.
• Rash.
• Headache.
• Fatigue.
• Dizziness.
• Yeast infection.

Each antibiotic medication for PID may have specific side effects or interactions with other medications.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

If side effects from the medication treatment occur, report them to your health professional. Other antibiotics may be prescribed that cause fewer side effects.

What To Think About

Antibiotics can prevent PID complications when started early and when all the medication is taken.

Tell your health professional if you think you might be pregnant. Some antibiotics are not recommended during pregnancy.

A follow-up examination should be performed 2 to 3 days after you start treatment. You should have less pain and tenderness during an abdominal and pelvic examination. Follow-up examinations at 7 to 10 days and 4 to 6 weeks are usually recommended to make sure treatment is successful.

If your symptoms have not improved, your health professional may try another medication regimen or look for other possible causes of your symptoms, including ectopic pregnancy, appendicitis, pelvic abscess, or endometriosis.

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Author:	Kathe Gallagher, MSW Carrie Henley	Last Updated: February 2, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Anne C. Poinier, MD - Internal Medicine Deborah A. Penava, BA, MD, FRCSC, MPH - Obstetrics and Gynecology
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