Pharmacologic treatment of acute pelvic inflammatory disease: a narrative review
- Author:
Sang Hyun CHO
1
Author Information
- Publication Type:Pharmacotherapeutics
- From:Journal of the Korean Medical Association 2026;69(3):255-264
- CountryRepublic of Korea
- Language:Korean
- Abstract: Acute pelvic inflammatory disease (PID) is an infection of the female upper genital tract, including the endometrium, fallopian tubes, ovaries, and adjacent pelvic structures. PID can lead to serious reproductive complications, such as tubal infertility, ectopic pregnancy, and chronic pelvic pain. Prompt initiation of empiric antibiotic therapy, with subsequent adjustment based on disease severity and clinical context, is essential. Recommended regimens consist of broad-spectrum antibiotics that target likely pathogens. This review summarizes the principles of antibiotic therapy and current guidelines for the management of acute PID.Current concepts: Empiric broad-spectrum antibiotics remain the cornerstone of PID management. Recommended regimens should provide coverage against Neisseria gonorrhoeae, Chlamydia trachomatis, anaerobic bacteria, and other facultative organisms, including Mycoplasma genitalium, which has emerged as a potential causative pathogen in some regions. Treatment should be initiated immediately upon clinical suspicion without awaiting microbiological confirmation, as delays significantly increase the risk of long-term sequelae.Discussion and conclusion: Key recommendations for PID include the following: (1) Use outpatient combination antibiotic therapy for mild to moderate disease. (2) Hospitalize and initiate parenteral therapy in cases of severe disease, pregnancy, suspected tubo-ovarian abscess, inability to tolerate oral therapy, or lack of clinical improvement within 72 hours. (3) Use cephalosporin-based regimens combined with doxycycline and metronidazole as first-line therapy, consistent with current Centers for Disease Control and Prevention guidelines. (4) Initiate treatment early, monitor closely, and adjust therapy as needed to optimize outcomes and minimize complications. (5) Notify and treat sexual partners to prevent reinfection and disease transmission.
