UMEM Educational Pearls

Category: Pharmacology & Therapeutics

Title: Treating PID in a Doxycycline-Allergic Patient

Keywords: doxycycline, PID, pelvic inflammatory disease, STD, azithromycin (PubMed Search)

Posted: 11/28/2012 by Bryan Hayes, PharmD (Emailed: 12/1/2012) (Updated: 12/1/2012)
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In the rare circumstance you need to treat a patient with suspected PID and an allergy to doxycycline, what is the alternative?

For oral regimens, azithromycin is an option in place of doxycycline.

  • In one randomized trial, azithromycin demonstrated short-term effectiveness when given 500 mg X 1, followed by 250 mg/day for 6 days.
  • In another randomized study, the combination of ceftriaxone 250 mg IM single dose and azithromycin 1 g orally once a week for 2 weeks was effective.

Suggested regimen for PID with doxycycline allergy:

  • Ceftriaxone 250 mg IM X 1
  • Azithromcyin 500 mg IV/PO X 1, then 250 mg PO daily for 6 days
  • plus/minus Metronidazole 500 mg PO twice daily for 14 days


Bevan CD, Ridgway GL, Rothermel CD. Efficacy and safety of azithromycin as monotherapy or combined with metronidazole compared with two standard multidrug regimens for the treatment of acute pelvic inflammatory disease. J Int Med Res 2003;31:45–54.

Savaris RF, Teixeira LM, Torres TG, et al. Comparing ceftriaxone plus azithromycin or doxycycline for pelvic inflammatory disease: a randomized controlled trial. Obstet Gynecol 2007;110:53–60.

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