Acute Pelvic Inflammatory Disease (PID)

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Acute PID refers to the acute syndrome attributed to the ascent of microorganisms, not related to pregnancy or surgery, from the vagina and cervix to the endometrium, fallopian tubes and adnexal structures. Gonorrhoea, chlamydia, mycoplasma, anaerobic bacteria and gram-negative organisms can cause acute PID.

Mild / Moderate Pelvic Inflammatory Disease

First line:

	Medicine	Adult dose	Frequency	Duration
	ceftriaxone im	250mg	once only
or	kanamycin im	2g	once only
and	doxycycline po	100mg	2 times a day	14 days
and	metronidazole po	400mg	3 times a day	14 days

Severe pelvic inflammatory disease

Temperature greater than 38°C with marked abdominal tenderness. Patients need IV fluids and IV medicines.

	Medicine	Adult Dose	Frequency	Duration
	ceftriaxone iv	2g	once a day	12 hours after clinical improvement
and	doxycycline po	100mg	twice a day	10 days
and	metronidazole pr	1g	12 hourly	for 72 hrs

Note: Duration as determined by patient's response. Switch to oral after review- treatment for 14 days

Alternative

	Medicine	Adult dose	Frequency	Duration
	ampicillin iv	500mg	6hourly	48-72hrs
and	gentamicin im	160mg	12hourly	48-72hrs
and	metronidazole pr	1g	12hourly	72hrs

Note: Duration as determined by patient's response. Switch to oral after

If no response within 48 hours suspect pelvic abscess and patient may need laparotomy or referral. Change to oral administration after temperature has settled.