Pelvic Inflammatory Disease

Antimicrobial prescribing: NHS Fife
NHS Fife

Clinical features

  • Pelvic and / or lower abdominal pain
  • Vaginal discharge
  • Pain during intercourse
  • Fever

Refer to GUM, especially If gonorrhoea likely (partner has it; sex abroad; severe symptoms)

Investigation

  • Blood culture
  • Urine culture
  • High vaginal swab for culture (charcoal)
  • Vulvovaginal swab OR self-obtained lower vaginal swab for Chlamydia and gonorrhoea PCR (COPAN) 

Infection Control

Basic universal precautions

Treatment

Continue IV until at least 24h of clinical improvement seen, then consider IV to Oral switch

CEFTRIAXONE is a restricted antimicrobial for this indication and after the first dose, you will need an authorisation code

IV

CEFTRIAXONE IV 2g 24 hourly

PLUS

METRONIDAZOLE IV 500mg 8 hourly

PLUS

DOXYCYCLINE PO 100mg 12 hourly

If unable to tolerate oral Doxycycline, instead use:

CIPROFLOXACIN IV 400mg 12 hourly (review MHRA Safety Advice before prescribing)

If true penicillin allergy:

CLINDAMYCIN IV

900mg 6 hourly

PLUS

GENTAMICIN IV (dose as per calculator)

ORAL

DOXYCYCLINE PO 100 mg 12 hourly

PLUS

METRONIDAZOLE PO 400mg 12 hourlyDuration 14 days