These regimens have been proposed by the Bromley hospitals following discussions between the Departments of Obstetrics & Gynaecology, Genitourinary Medicine, Microbiology, and the Pharmacy Department.
Note: If intravenous therapy is required, it should replace the oral regimen for the first 48 hours, and the remainder of the course should then be completed with the oral treatment.
Regimen 1 – First-line
Intravenous
- Cefuroxime 750 mg IV tds for 48 hours
- Metronidazole 1 g PR tds for 48 hours
- and start Doxycycline 100 mg orally
Oral
- Cefadroxil 500 mg PO bd for 7 days
- Metronidazole 400 mg PO bd for 7 days
- Doxycycline 100 mg bd for a total of 14 days
Note: Patients with suspected chlamydia-related pelvic inflammatory disease should start doxycycline immediately. If chlamydia is subsequently confirmed, and unless sensitivity testing indicates otherwise, the cephalosporin will not be necessary. For more severe cases, and in cases where the diagnosis is less certain, the use of the triple regimen provides broader coverage and should be given until microbiology results are available.
Regimen 2 – Alternative regimen (useful if Regimen 1 is not tolerated)
Intravenous
- Co-amoxiclav 1.2 g IV tds for 48 hours
- and start Doxycycline 100 mg orally bd
Oral
- Co-amoxiclav 250/125 orally, 2 tablets for 7 days
- Doxycycline 100 mg orally bd for a total of 14 days
Note: The optimal dose and duration of co-amoxiclav (Augmentin) in pelvic inflammatory disease have not been clearly established. Oral regimens reported in the literature vary from 375 mg to 1.2 g taken 3–4 times per day.
