The CDC 2021 STI Treatment Guidelines recommend outpatient oral treatment for mild-to-moderate PID. Which antibiotic combination is currently recommended for outpatient oral treatment of PID, including coverage for Neisseria gonorrhoeae and Chlamydia trachomatis?
- A Ciprofloxacin 500 mg BD × 14 days + metronidazole 500 mg BD × 14 days
- B Ceftriaxone 500 mg IM single dose + doxycycline 100 mg BD × 14 days + metronidazole 500 mg BD × 14 days ✓
- C Amoxicillin-clavulanate 875/125 mg BD × 14 days + azithromycin 1g single dose
- D Ofloxacin 400 mg BD × 14 days + doxycycline 100 mg BD × 14 days
Explanation
CDC 2021 STI Treatment Guidelines updated PID treatment to reflect increasing fluoroquinolone resistance in N. gonorrhoeae, moving away from ofloxacin/ciprofloxacin-based regimens for first-line PID treatment. The recommended outpatient regimen is now: ceftriaxone 500 mg IM single dose (1000 mg if weight ≥150 kg) PLUS doxycycline 100 mg orally twice daily for 14 days PLUS metronidazole 500 mg orally twice daily for 14 days. Ceftriaxone covers gonorrhoeae (including fluoroquinolone-resistant strains), doxycycline covers Chlamydia and enhances polymicrobial coverage, and metronidazole covers anaerobes (important for the 'upper tract extension' flora). Fluoroquinolone-based regimens are now reserved for cases where cephalosporins cannot be used.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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