A 28-year-old woman presents with lower abdominal pain, mucopurulent cervical discharge, and cervical motion tenderness. Pelvic inflammatory disease is suspected. What is the first-line antibiotic regimen for outpatient management of uncomplicated PID?

## First-Line Outpatient PID Regimen **Key Point:** The CDC and WHO recommend ceftriaxone + doxycycline ± metronidazole as the gold standard for outpatient PID management. ### Rationale for Ceftriaxone + Doxycycline **High-Yield:** This combination provides: - **Ceftriaxone 250 mg IM** — covers *Neisseria gonorrhoeae* (including resistant strains) and many gram-negative organisms - **Doxycycline 100 mg PO BD × 14 days** — covers *Chlamydia trachomatis* and atypical organisms ### Spectrum Coverage | Pathogen | Ceftriaxone | Doxycycline | |----------|-------------|-------------| | *N. gonorrhoeae* | ✓ | ✗ | | *C. trachomatis* | ✗ | ✓ | | Gram-negative rods | ✓ | ✓ | | Anaerobes | ✗ | ± | **Clinical Pearl:** Metronidazole 500 mg BD × 14 days may be added if anaerobic coverage is desired (especially in severe disease or IUD users), but is not mandatory for uncomplicated outpatient PID. ### Why IM Ceftriaxone? - Superior bioavailability and tissue penetration compared to oral cephalosporins - Single-dose convenience improves compliance - Covers resistant gonorrhea strains (CMRNG, PPNG) **Mnemonic:** **CTD** = **C**eftriaxone + **T**etracycline/Doxycycline = **D**efault PID regimen [cite:Park 26e Ch 18]