Doxycycline for PID: Dosage, Treatment & What to Expect

Pelvic Inflammatory Disease (PID) is a polymicrobial infection of the upper female reproductive tract (uterus, fallopian tubes, ovaries). **Doxycycline is a cornerstone of outpatient PID regimens** per CDC guidelines.

Standard Regimen (CDC 2021)

• **Ceftriaxone 500 mg IM single dose** (1 g if ≥150 kg) **PLUS**
• **Doxycycline 100 mg PO twice daily × 14 days**
• **PLUS Metronidazole 500 mg PO twice daily × 14 days** (covers anaerobes, BV-associated organisms).

Doxycycline Specifics

• **Dose:** 100 mg BID × 14 days (critical: full course).
• **Administration:** With full glass of water; remain upright 30 min to prevent esophageal ulceration. Take with food if GI upset (slightly reduces absorption).
• **Contraindications:** Pregnancy (tetracycline class – fetal teeth/bone), children <8 years, severe hepatic impairment.
• **Interactions:** Antacids (Ca/Mg/Al/Fe), warfarin (↑INR), oral contraceptives (backup method), penicillin (bacteriostatic vs. bactericidal).
• **Photosensitivity:** High risk; use SPF 30+, protective clothing.

Adjunctive Measures

• **Abstain** from sex until patient + partner(s) completed treatment.
• **Partner Treatment:** Expedited Partner Therapy (EPT) where legal; otherwise refer.
• **STI Testing:** HIV, syphilis, gonorrhea, chlamydia, trichomonas.
• **IUD:** Can remain in place if clinical improvement; remove if no improvement 48–72h.
• **Follow-up:** 72 hrs (assess response), 4–6 weeks (test of cure if pregnant).

Red Flags (Hospitalize)

• Tubo-ovarian abscess, pregnancy, severe illness, nausea/vomiting preventing PO, immunodeficiency, surgical emergency (appendicitis), adolescent noncompliance risk.