A 24-year-old woman at 14 weeks of gestation presents with lower abdominal pain, cervical motion tenderness, and fever. A diagnosis of pelvic inflammatory disease in pregnancy is made. Which parenteral regimen is appropriate?

• A Cefoxitin plus doxycycline plus metronidazole
• B Ofloxacin plus metronidazole
• C Ceftriaxone plus azithromycin ✓
• D Clindamycin plus gentamicin alone, without cephalosporin cover

Explanation

Tetracyclines are contraindicated in pregnancy because of tooth discoloration and effects on fetal bone, so doxycycline must be replaced by azithromycin. Fluoroquinolones such as ofloxacin are also avoided in pregnancy. The accepted approach is a third-generation cephalosporin such as ceftriaxone combined with azithromycin, with metronidazole added when anaerobic cover or an abscess is suspected.

Reference: CDC STI Treatment Guidelines, 2021 ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.