Examples

Pelvic inflammatory disease (PID) is often caused by a combination of different types of bacteria, so a combination (regimen) of medicines is used to treat the infection. Treatment changes as new medicines are developed or as the bacteria that cause the infection become resistant to old medicines. Treatment guidelines from the U.S. Centers for Disease Control and Prevention recommend one of the following regimens:¹

Outpatient treatment options

Ceftriaxone plus doxycycline with or without metronidazole

Ceftriaxone is given one time as an injection in a muscle. Doxycycline is taken as pills twice a day usually for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline. Metronidazole is taken as pills twice a day usually for 14 days. Do not drink alcohol when taking metronidazole. The number of days you continue to take antibiotics depends on your illness and the type of antibiotic medicine.

Cefoxitin with probenecid plus doxycycline with or without metronidazole

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 usually for 14 days. Doxycycline is not used if you are pregnant. Avoid prolonged sun exposure while taking doxycycline. Metronidazole is taken as pills twice a day usually for 14 days. Do not drink alcohol when taking metronidazole. The number of days you continue to take antibiotics depends on your illness and the type of antibiotic medicine.

Other antibiotic medicines are sometimes used for treating PID.

Inpatient treatment options

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 treatment with medicine usually lasts for 14 days.²

� Inpatient intravenous, regimen A

Cefotetan

Cefotetan is given intravenously every 12 hours.

OR:

Cefoxitin plus doxycycline

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

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 and/or clindamycin) are given.

� Alternative intravenous regimen

Ampicillin/sulbactam plus doxycycline

Ampicillin/sulbactam is given intravenously every 6 hours. Doxycycline is given intravenously or in pill form every 12 hours.

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

All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

Here are some important things to think about:

• Usually the benefits of the medicine are more important than any minor side effects.
• Side effects may go away after you take the medicine for a while.
• If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

Call911or other emergency services right away if you have:

• Trouble breathing.
• Hives.
• Swelling of your face, lips, tongue, or throat.

Ceftriaxone or cefoxitin

Call your doctor right away if you have:

• Black or bloody stools.
• Unusual bleeding or bruising.
• Fever and chills.

Metronidazole

Call your doctor right away if you have:

• Numbness, tingling, pain, or weakness in your hands or feet.

Common side effects of these medicines include:

• Diarrhea.
• Nausea or vomiting.
• Headache.
• Belly pain or cramps.
• Dizziness.

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

What To Think About

Doxycycline

Doxycycline can make your skin more sensitive to the sun.

• Stay out of the sun, if possible.
• Wear long pants, long-sleeved shirts, and hats, if possible.
• Use sunscreen with a sun protection factor (SPF) that your doctor recommends.

Metronidazole

• Completely avoid alcohol use (including nonprescription nighttime cold medicines, such as NyQuil) when you are taking metronidazole. Combining alcohol with this medicine may cause severe nausea and vomiting.

Taking medicine

Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

Advice for women

Ceftriaxone or cefoxitin

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Doxycycline

Oral contraceptives (birth control pills) may not work as well while you are taking doxycycline. Talk to your doctor about how you can avoid pregnancy.

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Metronidazole

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Clindamycin and gentamicin

If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.

Checkups

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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