560. CDC criteria for hospitalization of PID / Inpatient Rx / Outpatient Rx

October 26th, 2008
by reuben in STD

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Responses to “560. CDC criteria for hospitalization of PID / Inpatient Rx / Outpatient Rx”

  1. Quinolones no longer sufficiently cover gonorrhea. Below is the recommendation from the Hopkins Antiobiotics Guide:

    Oral/Outpatient Treatment of Mild to Moderately Severe Acute PID

    * Ceftriaxone 250 mg IM x 1 PLUS doxycycline 100 mg PO bid x 14d with or without metronidazole 500 mg PO bid x 14d.
    * Cefoxitin 2 g IM PLUS probenecid 1 g PO x 1 PLUS doxycycline 100 mg PO BID x 14 d with or without metronidazole 500 mg PO bid x 14d.
    * Other parenteral 3rd generation cephalosporin PLUS doxycycline 100 mg PO bid x 14 d with or without metronidazole 500 mg PO bid x 14 d.

    Inpatient/Parenteral Regimens for PID

    * Cefotetan 2g IV q12h (no longer available in US) or cefoxitin 2g IV q6h PLUS doxycycline 100 mg IV or PO q12h for at least 24h after clinical improvement, then outpatient regimen to complete 14 d.
    * Clindamycin 900 mg IV q8h PLUS gentamicin loading dose IV/IM (2 mg/kg), then 1.5 mg/kg q8h or 5 mg/kg once daily for at least 24h after clinical improvement, then change to outpatient regimen to complete 14d.
    * Alternative parenteral regimen: ampicillin/sulbactam 3 g IV q6h PLUS doxycycline 100 mg IV or PO q12h for at least 24 hrs after clinical improvement; then change to outpatient regimen to complete 14 d.

    Alternative Oral Regimens if Parenteral Therapy Not Feasible

    * If community prevalence and risk of gonococcal infection is LOW (<5%): Levofloxacin 500 mg PO once daily or ofloxacin 400 mg PO q12h with or without metronidazole 500 mg IV q8h, for at least 24h after clinical improvement, then change to outpatient regimen to complete 14 d. Tests for gonorrhea must be performed prior to instituting treatment and the patient managed as follows if the test is positive for N. gonorrhoeae: 1) if a non-culture test is used and is positive, a parenteral cephalosporin regimen is recommended; 2) if culture for gonorrhea is positive, treatment should be based upon results of antimicrobial susceptibility. If the the isolate is fluoroquinolone resistant or resistance cannot be assessed, parenteral cephalosporin therapy is recommended.

    Penicillin or Cephalosporin Allergic Patients

    * Patients with a history of cephalosporin or penicillin allergy should be referred to a specialist for evaluation and possible desensitization prior to treatment with either a penicillin or cephalosporin.
    * In areas where <5% of all gonococcal isolates identified by culture and sensitivity testing in the past 6 months have been found to be fluoroquinolone resistant providers may consider use of levofloxacin as outlined above under "Alternative Oral Regimens if Parenteral Therapy Not Feasible".
    * Spectinomycin efficacy in the treatment of pelvic inflammatory disease is too low and should not be used for treatment.

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