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As soon as pelvic inflammatory disease (PID) has been diagnosed, it needs to be treated with antibiotics. Two or more types of antibiotics may be taken at the same time. This ensures that all the bacteria are killed. It's very important to take all of your medicine as prescribed, or the infection may not go away. For mild casesMild cases of PID can be treated at home. Antibiotic pills will likely be prescribed. You may also get an injection of antibiotics. For more serious casesSevere cases of PID need to be treated in the hospital. There, you will get antibiotics through an IV (intravenous) line. Your health will be closely watched. The length of your hospital stay depends on how sick you are. After you leave the hospital, antibiotic pills will likely be prescribed. If complications have occurred, you may need surgery to help treat them. Make sure your partner gets treatedThe bacteria that cause PID can also have harmful effects in men. Any partner you have had sex with in the past 60 days should be treated for chlamydia and gonorrhea. Your partner must be treated with antibiotics as well. During treatmentFollow all your healthcare provider’s instructions. This will help you heal. During treatment:
If you take birth control pillsWhen both you and your partner have finished your antibiotics, it’s OK to have sex. Use latex condoms to prevent future infections. Also, keep taking your birth control pills on schedule. Remember: Birth control pills help prevent pregnancy, but do not protect against sexually transmitted infections (STIs). If the infection returnsEven after treatment, PID can come back. This could happen if you’re infected by another STI. But be aware that once you’ve had PID, bacteria that are normally harmless may be more likely to infect your upper genital tract. This means you could get PID again even without getting another STI. With each PID infection, the chances of complications go up. When to call your healthcare providerWhile you’re being treated for PID, call your healthcare provider if you have any of the following:
Medication SummaryTreatment of pelvic inflammatory disease (PID) should include empirical broad-spectrum antibiotics to cover the full complement of common causes. Antibiotics chosen should be effective against Chlamydia trachomatis and Neisseria gonorrhoeae, as well as against gram-negative facultative organisms, anaerobes, and streptococci. The Centers for Disease Control and Prevention (CDC) has outlined antibiotic regimens for outpatient and inpatient treatment of PID. MacrolidesClass SummaryMacrolides are a class of antibiotics discovered in the bacterium Streptomyces. These agents are characterized by molecules made up of large-ring lactones. Many macrolides inhibit protein biosynthesis. Azithromycin (Zithromax, Zmax)
Azithromycin acts by binding to the 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Nucleic acid synthesis is not affected. This drug concentrates in phagocytes and fibroblasts, as demonstrated by in vitro incubation techniques. In vivo studies suggest that concentration in phagocytes may contribute to drug distribution to inflamed tissues. Azithromycin is used to treat mild-to-moderate microbial infections. Plasma concentrations are very low, but tissue concentrations are much higher, giving the drug value in treating intracellular organisms. Azithromycin has a long tissue half-life. Azithromycin is related to erythromycin. It is considered by many to be treatment of choice for C trachomatis genitourinary infection because it may be administered as a single dose, which improves adherence to treatment. Cephalosporins, 3rd GenerationClass SummaryCephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid. Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Third-generation cephalosporins are less active against gram-positive organisms then first-generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and Haemophilus influenzae. Ceftriaxone (Rocephin)
Cephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid. Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Third-generation cephalosporins are less active against gram-positive organisms then first-generation cephalosporins are. They are highly active against Enterobacteriaceae, Neisseria, and Haemophilus influenzae. Cefotaxime (Claforan)Cefotaxime is a third-generation cephalosporin with a broad gram-negative spectrum, lower efficacy against gram-positive organisms, and higher efficacy against resistant organisms. It arrests bacterial cell wall synthesis by binding to 1 or more of the penicillin-binding proteins, thereby in turn inhibiting bacterial growth. Cefotaxime is used to treat bloodstream infection and gynecologic infections caused by susceptible organisms. Ceftizoxime (Cefizox)
Ceftizoxime is a third-generation cephalosporin with broad-spectrum gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Its gram-negative spectrum includes Moraxella catarrhalis. Dose selection depends on the severity of the infection and the susceptibility of the organism. Cephalosporins, 2nd GenerationClass SummaryCephalosporins are a group of broad-spectrum, semisynthetic beta-lactam antibiotics that are derived from the mold Cephalosporium (now termed Acremonium). They interfere with bacterial cell wall synthesis. Cephalosporin N and C are chemically related to penicillins, and cephalosporin P resembles fusidic acid. Cephalosporins are grouped into generations according to their spectrum of antimicrobial activity. Compared with first-generation cephalosporins, second-generation agents have increased activity against gram-negative bacteria and decreased activity against gram-positive bacteria. Cefoxitin (Mefoxin)
Cefoxitin is a second-generation cephalosporin indicated for infections with gram-positive cocci and gram-negative rods. Infections caused by cephalosporin- or penicillin-resistant gram-negative bacteria may respond to cefoxitin. Cefotetan (Cefotan)
Cefotetan is a second-generation cephalosporin indicated for infections caused by susceptible gram-positive cocci and gram-negative rods. The dose and route of administration depend on the condition of the patient, the severity of infection, and the susceptibility of the causative organism. TetracyclinesClass SummaryTetracyclines are bacteriostatic broad-spectrum antibiotics derived from cultures of Streptomyces bacteria; they inhibit protein synthesis in susceptible organisms. These agents work by reversibly binding to the 30S ribosome of the microbial RNA and preventing the attachment of aminoacyl-tRNA with the acceptor site on the 70S ribosome. Doxycycline (Vibramycin)
Doxycycline inhibits protein synthesis and, thus, bacterial growth by binding to 30S and possibly 50S ribosomal subunits of susceptible bacteria. Antibiotics, OtherClass SummaryLincosamide antibiotics (eg, clindamycin) inhibit protein synthesis. Imidazole antibiotics (eg, metronidazole) arrest RNA-dependent protein synthesis. Clindamycin (Cleocin)Clindamycin is a lincosamide used for treatment of serious skin and soft tissue staphylococcal infections. It is also effective against aerobic and anaerobic streptococci (except enterococci). It inhibits bacterial growth, possibly by blocking dissociation of peptidyl tRNA from ribosomes, causing RNA-dependent protein synthesis to arrest. Metronidazole (Flagyl)
An imidazole ring–based antibiotic active against various anaerobic bacteria and protozoa, metronidazole is used in combination with other antimicrobial agents (except for treatment of Clostridium difficile enterocolitis). AminoglycosidesClass SummaryAminoglycosides are a group of injectable bactericidal antibiotics that act by inhibiting bacterial protein synthesis. All aminoglycosides share the potential for ototoxicity and nephrotoxicity. Gentamicin (Garamycin)
Gentamicin is an aminoglycoside antibiotic that provides gram-negative coverage. It is used in combination with an agent that is effective against gram-positive organisms and one that covers anaerobes. Dosing regimens are numerous. Adjust dose on the basis of creatinine clearance and changes in volume of distribution. Measure at least a trough level, drawn on the third or fourth dose (0.5 hours before dosing); a peak level may be drawn 0.5 hours after a 30-minute infusion. Penicillins, AminoClass SummaryAn acid-stable semisynthetic penicillin, ampicillin has a broader spectrum of antimicrobial action than penicillin G does. It inhibits the growth of gram-positive and gram-negative bacteria. It is not resistant to penicillinase, but when it is combined with the beta-lactamase inhibitor sulbactam, the spectrum of activity is increased. Ampicillin-sulbactam (Unasyn)
This formulation combines ampicillin with a beta-lactamase inhibitor. It interferes with bacterial cell wall synthesis during active replication, causing bactericidal activity against susceptible organisms. Uricosuric AgentsClass SummaryUricosuric agents are used to increase serum concentrations of certain antibiotics and other drugs. Probenecid
Probenecid inhibits tubular secretion of penicillin and usually increases penicillin plasma levels, regardless of the route of penicillin administration. It is used as an adjuvant to therapy with penicillin, ampicillin, methicillin, oxacillin, cloxacillin, or nafcillin. A 2- to 4-fold elevation of penicillin plasma levels is demonstrated.
Author Kristi A Tough DeSapri, MD Clinical Assistant Professor of Obstetrics and Gynecology, Director of Comprehensive Bone Center, University of Chicago Medicine Women's Care Kristi A Tough DeSapri, MD is a member of the following medical societies: American Society for Colposcopy and Cervical Pathology, North American Menopause Society Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Amgen and AMAG pharmaceuticals. Coauthor(s) Monica M Christmas, MD, FACOG, NCMP Assistant Professor, Department of Obstetrics and Gynecology, Section of Minimally Invasive Gynecologic Surgery, Director of Menopause Program, Chief Menopause Editor and Co-Investigator, WomanLab, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine Monica M Christmas, MD, FACOG, NCMP is a member of the following medical societies: American College of Obstetricians and Gynecologists, North American Menopause Society, Society for Academic Specialists in General Obstetrics and Gynecology Disclosure: Nothing to disclose. Chief Editor Acknowledgements Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment What is the best medicine for pelvic inflammatory disease?Guidelines of the Centers for Disease Control and Prevention recommend outpatient treatment of PID with ofloxacin, levofloxacin, ceftriaxone plus doxycycline, or cefoxitin and probenecid plus doxycycline, all with optional metronidazole for full coverage against anaerobes and bacterial vaginosis (table 1) [13].
What antibiotics treat pelvic inflammatory disease?Oral therapy usually involves doxycycline; however, azithromycin can also be used. In patients who have developed a TOA, oral therapy should include clindamycin or metronidazole. All patients should be reevaluated in 72 hours for evidence of clinical improvement and compliance with their antibiotic regimen.
How long does it take for pelvic inflammatory disease to clear up?Treating the Infection
To fully treat PID, you may need to take one or more antibiotics. Taking antibiotic medicine will help clear the infection in about 2 weeks.
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What medication is used for pelvic inflammatory disease
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