What are the first-line antibiotic regimens for treating uncomplicated PID in primary care?

First-line antibiotic regimens for treating uncomplicated pelvic inflammatory disease (PID) in primary care involve a combination therapy to cover likely pathogens including Neisseria gonorrhoeae, Chlamydia trachomatis, and anaerobic bacteria.

For women at high risk of gonococcal infection, the recommended regimen is intramuscular ceftriaxone 1 g as a single dose, followed by oral doxycycline 100 mg twice daily plus oral metronidazole 400 mg twice daily for 14 days.

For women at low risk of gonococcal infection, the same regimen is advised: IM ceftriaxone 1 g single dose plus doxycycline 100 mg twice daily and metronidazole 400 mg twice daily for 14 days.

The use of doxycycline plus metronidazole without ceftriaxone is not recommended due to limited evidence and higher treatment failure rates.

Oral cephalosporins such as cefixime are not recommended because of lower tissue levels and lack of clinical trial evidence.

Fluoroquinolones (e.g., ofloxacin, moxifloxacin) should be avoided as first-line treatment due to resistance and risk of serious side effects.

The typical duration of treatment is 10–14 days.