A woman with PID requires admission. According to CDC 2021 PID treatment guidelines, which combination is recommended as the PREFERRED parenteral regimen?

• A Clindamycin 900 mg IV every 8 hours + Gentamicin IV (2 mg/kg load, then 1.5 mg/kg every 8 hours)
• B Piperacillin-tazobactam 3.375 g IV every 6 hours + Doxycycline 100 mg twice daily
• C Ampicillin-sulbactam 3g IV every 6 hours + Doxycycline 100 mg twice daily
• D Ceftriaxone 1g IV daily + Doxycycline 100 mg IV/orally twice daily ± Metronidazole 500 mg twice daily ✓

Explanation

CDC 2021 STI Treatment Guidelines recommend two preferred parenteral PID regimens: (1) Ceftriaxone 1g IV once daily PLUS doxycycline 100 mg orally or IV twice daily WITH OR WITHOUT metronidazole 500 mg orally/IV twice daily; and (2) Cefoxitin 2g IV every 6 hours PLUS doxycycline 100mg every 12 hours. Clindamycin + gentamicin is an alternative parenteral regimen, not the preferred option. Ceftriaxone + doxycycline covers Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobes; metronidazole addition improves anaerobic coverage particularly if BV coexists.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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