A 24-year-old woman presents with lower abdominal pain, fever, and purulent cervical discharge. On examination, she has cervical motion tenderness and adnexal tenderness bilaterally. Pregnancy test is negative. Her WBC count is 14,000/µL. She is hemodynamically stable. Which of the following is the MOST appropriate outpatient antibiotic regimen according to CDC 2021 guidelines?
- A Oral doxycycline 100 mg BD for 14 days
- B IM ceftriaxone 500 mg single dose + oral doxycycline 100 mg BD + metronidazole 500 mg BD for 14 days ✓
- C Oral azithromycin 1 g single dose + oral metronidazole for 7 days
- D IV cefoxitin 2 g every 6 hours + oral doxycycline for inpatient treatment
Correct answer: B. IM ceftriaxone 500 mg single dose + oral doxycycline 100 mg BD + metronidazole 500 mg BD for 14 days
Explanation
CDC 2021 STI Treatment Guidelines recommend the following outpatient regimen for PID: ceftriaxone 500 mg IM single dose (or 1 g if weight >150 kg) + doxycycline 100 mg BD + metronidazole 500 mg BD for 14 days. This covers Neisseria gonorrhoeae (ceftriaxone), Chlamydia trachomatis (doxycycline), and anaerobes (metronidazole). Doxycycline alone is inadequate. IV regimens are for inpatient treatment, which is indicated for failure of outpatient therapy, surgical emergencies, severe illness, or inability to tolerate oral medication.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.