Pelvic inflammatory disease (PID) is usually treated with antibiotics to provide empiric, broad-spectrum coverage of likely pathogens. Several types of antibiotics can cure PID, and recommended regimens can be found in the 2021 STI Treatment Guidelines. The antibiotics used to treat PID should be effective against N. gonorrhoeae and C. trachomatis, which are common causes of PID. The following antibiotics are commonly used to treat PID:

• Ceftriaxone 250 mg intramuscularly (IM) once as a single dose plus cefoxitin 2 g IM once as a single dose concurrently with probenecid 1 g orally in a single dose; or
• Cefoxitin 2 g intramuscularly (IM) plus probenecid 1 g orally in a single dose followed by doxycycline 100 mg orally twice a day for 14 days with or without metronidazole 500 mg orally twice a day for 14 days; or
• Other parenteral third-generation cephalosporin (ceftizoxime or cefotaxime) plus doxycycline 100 mg orally twice a day for 14 days with or without metronidazole 500 mg orally twice a day for 14 days; or
• Ampicillin/sulbactam 3 g intravenously (IV) every 6 hours plus doxycycline 100 mg orally or IV every 12 hours with or without metronidazole 500 mg orally or IV every 6 hours.

Azithromycin has also been shown to be effective for the treatment of PID, and it has been shown to be superior to doxycycline in terms of compliance, side effects, and microbiologic cure. The antibiotics used to treat PID should be taken for the full course, even if the symptoms go away before the infection is cured. Additionally, a woman’s sex partner(s) should be treated to decrease the risk of re-infection, even if the partner(s) has no symptoms. In some cases, clinicians may recommend hospitalization to treat PID.