A 23-year-old woman is diagnosed clinically with mild-to-moderate PID and is suitable for outpatient management. Microbiology results are not yet available. What is the most appropriate antibiotic approach?

Answer: A. Start empirical broad-spectrum antibiotics (e.g. IM ceftriaxone plus oral doxycycline and metronidazole) immediately

Empirical treatment of PID

Because early treatment reduces long-term sequelae (tubal infertility, ectopic pregnancy, chronic pelvic pain), empirical broad-spectrum antibiotics are started before microbiology results.

Recommended outpatient regimen

• Ceftriaxone 1 g IM single dose (covers gonorrhoea), followed by
• Oral doxycycline 100 mg twice daily (covers chlamydia and Mycoplasma genitalium) plus metronidazole 400 mg twice daily for 14 days (covers anaerobes).
• Alternatives include ofloxacin + metronidazole, or moxifloxacin.

Why broad-spectrum

PID is often polymicrobial (chlamydia, gonorrhoea, Gardnerella, Mycoplasma genitalium, anaerobes), so the regimen must cover gonococci, chlamydia and anaerobes.

Why the others are wrong

Withholding antibiotics risks tubal damage; single-agent amoxicillin or short metronidazole does not cover the likely organisms; antifungal cream treats candida, not PID. Treat partners and screen for other STIs.