A 25-year-old woman has PID with a 5 cm tubo-ovarian complex on ultrasound. She is admitted and treated with IV cefoxitin plus doxycycline. After 48 hours of IV therapy, she shows clinical improvement. The MOST appropriate next step is:

• A Continue IV antibiotics for a total of 14 days
• B Laparoscopic drainage of the tubo-ovarian complex
• C Add IV metronidazole and extend IV course to 21 days
• D Transition to oral doxycycline 100 mg twice daily to complete 14 days total ✓

Explanation

CDC guidelines for hospitalized PID with tubo-ovarian complex: continue IV antibiotics for at least 24 hours after clinical improvement, then transition to oral therapy. Oral doxycycline 100 mg twice daily to complete a total 14-day course (with oral metronidazole 500 mg twice daily if TOC is present) is appropriate. Continued IV therapy for 14 days is unnecessary once oral absorption is adequate. Laparoscopic drainage is reserved for TOC that fails to respond after 72 hours of IV therapy.

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

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Written and medically reviewed by the StethoPrep medical team.