Pelvic Inflammatory Disease

• Consult readily with Sexual Health or Gynaecology.
• Treat partner with a stat dose of azithromycin as below.
• Mixed infections are common.
• Even if pathogen is known, broad spectrum therapy may be indicated.

Pathogens

• Common: N. gonorrhoeae, Chlamydia trachomatis, Enterobacteriaceae, Streptococcus species, anaerobes
• Other: C. perfringens, Group A Streptococcus

Drug Treatment

• Duration: See below.

Empiric

Mild/Moderate disease

If GI side effects with the below combinations are too severe - stop metronidazole.

ceftriaxone HMLSchedNZFPMLnoids Ceftriaxone F: n/a Half life: 8 hours Elimination: 50% renal and 50% biliary excretion fe: 0.5

IM 500 mg stat

AND

metronidazole HMLSchedNZFPMLnoids Metronidazole F: 1 Half life: 8 hours Elimination: oxidation, glucuronidation fe: 0.1

PO 400 mg twice a day for 2 weeks

• Metabolised by unknown pathways. (fe = 0.1).

AND EITHER

doxycycline HMLSchedNZFPML Doxazosin F: 0.7 Half life: 12 hours Elimination: CYP3A fe: 0.1

PO 100 mg twice a day for 2 weeks

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

OR, if pregnant or non-compliant

azithromycin HMLSchedNZFPML Azithromycin F: 0.4 Half life: 60 hours Elimination: substantial biliary excretion fe: 0.1 Additional points: ↑ warfarin effect.

PO 1000 mg stat weekly for 2 weeks

Severe penicillin allergy

gentamicin HMLSchedNZFPMLnoids Gentamicin F: n/a Half life: 3 hours Elimination: renal fe: 0.9 Additional points: TDM.

IV 5 mg/kg ideal body weight single dose

• fe = 0.9, adjust dose if CrCl reduced.

AND

• Metabolised by unknown pathways. (fe = 0.1).

AND

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

Failed/Severe disease

• fe = 0.5, consider adjusting dose if CrCl reduced.

AND

• High oral availability – prescribe orally unless GI absorption is compromised or patient is nil by mouth.
• Metabolised by unknown pathways. (fe = 0.1).

AND EITHER

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

OR, if pregnant

erythromycin ethylsuccinate HMLSchedPML Erythromycin F: 0.4 Half life: 2 hours Elimination: CYP3A fe: 0 Additional points: Inhibits CYP3A.

PO 800 mg four times a day for 2 weeks

• Metabolised by and strongly inhibits CYP3A.
• Subject to P-glycoprotein inhibition and induction.

Severe penicillin allergy

clindamycin HMLSchedNZFPMLnoids Clindamycin F: 0.9 Half life: 3 hours Elimination: CYP3A fe: 0.1

IV 600 mg every eight hours

• Metabolised by CYP3A. (fe < 0.1).

AND

• fe = 0.9, adjust dose if CrCl reduced.

followed by

• Metabolised by unknown pathways. (fe = 0.4).
• Avoid in pregnancy and breastfeeding.

AND

• Metabolised by unknown pathways. (fe = 0.1).

Topic Code: 99241

must be prescribed or recommended by a consultant.