Question 3 - Pelvic Inflammatory Disease (PID) Question Bank

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Pelvic Inflammatory Disease (PID)Question 3/5

A 31-year-old woman is diagnosed with pelvic inflammatory disease. She denies any nausea or vomiting, and she prefers to have outpatient therapy. A pregnancy test is performed and it is negative. She weighs 57 kg.

Which one of the following is an appropriate outpatient antimicrobial regimen for treating mild-to-moderate pelvic inflammatory disease (PID)?

Cefixime 400 mg orally once daily for 7 days plus doxycycline 100 mg orally twice daily for 14 days plus metronidazole 500 mg twice daily for 14 days

Ceftriaxone 250 mg in a single intramuscular dose plus azithromycin 1 g orally as a single dose plus tinidazole 2 g orally as a single dose

Ceftriaxone 500 mg in a single intramuscular dose plus levofloxacin 500 mg once daily for 14 days

Ceftriaxone 500 mg in a single intramuscular dose plus doxycycline 100 mg orally twice daily for 14 days plus metronidazole 500 mg twice daily for 14 days

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Question Last Updated
March 13th, 2025

Table 1. 2021 STI Treatment Guidelines: Pelvic Inflammatory Disease (PID)
Intramuscular or Oral Regimens

For women with mild-to-moderate acute PID, intramuscular (IM) or oral therapy can be considered because the clinical outcomes among women treated with these regimens are similar to those treated with IV therapy. Women who do not respond to IM/oral therapy within 72 hours should be reevaluated to confirm the diagnosis and should be administered intravenous therapy.

Recommended Regimens

Ceftriaxone

Tradename:Rocephin

500 mg IM in a single dose*

Doxycycline

Tradename:Doryx, Vibramycin

100 mg orally twice a day for 14 days+

Metronidazole

Tradename:Flagyl

500 mg orally twice a day for 14 days+

*For persons weighing ≥150 kg, 1 gm of ceftriaxone should be administered.

Recommended Regimens

Cefoxitin

Tradename:Mefoxin

2 g IM in a single dose

Probenecid

Tradename:

1 g orally in a single dose (given concurrently with cefoxitin)+

Doxycycline

Tradename:Doryx, Vibramycin

100 mg orally twice a day for 14 days+

Metronidazole

Tradename:Flagyl

500 mg orally twice a day for 14 days+

The cefoxitin and probenecid should be administered concurrently.

Recommended Regimens

Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime)

Tradename:

Doxycycline

Tradename:Doryx, Vibramycin

100 mg orally twice a day for 14 days+

Metronidazole

Tradename:Flagyl

500 mg orally twice a day for 14 days+

Alternative Regimens

Levofloxacin

Tradename:Levaquin

500 mg orally once daily for 14 days

Metronidazole

Tradename:Flagyl

500 mg orally twice a day for 14 days+

Note: This alternative regimen is only for consideration if the patient has cephalosporin allergy, the community prevalence and individual risk for gonorrhea are low, and follow-up is likely.

Alternative Regimens

Moxifloxacin

Tradename:Avelox

400 mg orally once daily for 14 days

Note: This alternative regimen is only for consideration if the patient has cephalosporin allergy, the community prevalence and individual risk for gonorrhea are low, and follow-up is likely. Moxifloxacin is the preferred quinolone antimicrobial for M. genitalium infections; however, the importance of providing coverage for M. genitalium is unknown.

Alternative Regimens

Azithromycin

Tradename:Zithromax

500 mg IV daily for 1–2 doses, followed by 250 mg orally daily for a total of 7 days

Metronidazole

Tradename:Flagyl

500 mg orally three times a day for 12-14 days±

Note: This alternative regimen is only for consideration if the patient has cephalosporin allergy, the community prevalence and individual risk for gonorrhea are low, and follow-up is likely.

Source: Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. Pelvic inflammatory disease (PID). MMWR Recomm Rep. 2021;70(No. RR-4):1-187. [2021 STI Treatment Guidelines]

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

Chlamydial Infections

Gonococcal Infections

Syphilis

Genital Herpes

Human Papillomavirus Infection

Pelvic Inflammatory Disease

Vaginitis

Mpox

Mycoplasma genitalium

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Pelvic Inflammatory Disease (PID)Question 3/5

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Which one of the following is an appropriate outpatient antimicrobial regimen for treating mild-to-moderate pelvic inflammatory disease (PID)?

Table 1. 2021 STI Treatment Guidelines: Pelvic Inflammatory Disease (PID)Intramuscular or Oral Regimens

Ceftriaxone

Doxycycline

Metronidazole

Cefoxitin

Probenecid

Doxycycline

Metronidazole

Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime)

Doxycycline

Metronidazole

Levofloxacin

Metronidazole

Moxifloxacin

Azithromycin

Metronidazole

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Table 1. 2021 STI Treatment Guidelines: Pelvic Inflammatory Disease (PID)
Intramuscular or Oral Regimens