Dawaa Reference

infectious

Pelvic inflammatory disease (PID outpatient therapy)

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources8 sources

CDC STI Treatment Guidelines 2021 · Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph) · Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph) · BASHH UK national guideline for the management of pelvic inflammatory disease, 2018, with the 2019 interim update: "i.m. ceftriaxone 1g single dose followed by oral doxycycline 100mg twice daily plus metronidazole 400mg twice daily for 14 days" · BASHH 2019 Interim Update - UK National Guideline for the Management of Pelvic Inflammatory Disease (outpatient regimens, second line therapy) · MSF Essential Drugs 2024 - paracetamol (oral) · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)

Verified against8 documents
  • Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)
  • Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph)
  • BASHH UK national guideline for the management of pelvic inflammatory disease, 2018, with the 2019 interim update: "i.m. ceftriaxone 1g single dose followed by oral doxycycline 100mg twice daily plus metronidazole 400mg twice daily for 14 days"
  • BASHH 2019 Interim Update - UK National Guideline for the Management of Pelvic Inflammatory Disease (outpatient regimens, second line therapy)
  • MSF Essential Drugs 2024 - paracetamol (oral)
  • Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)
  • Pelvic Inflammatory Disease - disease-level clinical article (pelvic-inflammatory-disease-clinical.txt)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (6)

  • The pain typically affects both sides and its intensity varies widely, though some patients have no symptoms at all [abdominal pain · pelvic pain]
  • An IUD raises PID risk only in the first 3 weeks after insertion, not afterward
  • Right upper quadrant pain that radiates to the shoulder suggests spreading infection causing Fitz-Hugh-Curtis perihepatitis [abdominal pain · right upper quadrant pain]
  • It is an ascending infection from the lower genital tract that can reach the uterus, the fallopian tubes and the ovaries, and most cases trace back to a sexually transmitted infection
  • Red flag: the short-term complication is a tubo-ovarian or pelvic abscess, and the long-term ones are infertility, ectopic pregnancy and chronic pelvic pain [abdominal pain · abscess · infertility · pelvic pain]
  • Diagnosing and treating it early is what prevents the tubal damage those complications come from

Signs — what you find (2)

  • Tenderness on cervical motion plus uterine and adnexal tenderness on bimanual exam is the classic finding [abdominal pain · pelvic pain]
  • A palpable adnexal mass raises concern for a tubo-ovarian abscess [abscess · pelvic mass]

Tests (4)

  • A pregnancy test is done to rule out an ectopic pregnancy as the cause of the pain
  • Negative endocervical swab testing for chlamydia and gonorrhea does not rule out PID
  • Ultrasound may show dilated fluid-filled tubes, a cogwheel appearance, or a complex adnexal mass, but a normal scan does not exclude PID
  • The diagnosis is primarily clinical: suspect it in a woman whose lower abdominal or pelvic pain comes with marked tenderness when the internal genitalia are palpated

If not this — what else fits (3)

  • Ectopic pregnancy and a ruptured ovarian cyst are both key differentials for pelvic pain in this setting
  • Adnexal torsion and endometriosis are also considered when evaluating similar pelvic pain
  • Urinary tract infection, including pyelonephritis, is also on the differential for pelvic pain

SourceStatPearls "Pelvic Inflammatory Disease" - disease-level clinical article

Presentation findings are traced to the source above.

Combination safety

Combination regimens

!! MULTI-DRUG REGIMEN - all 3 drugs are given TOGETHER. Not a choice between them.

!! the regimen: Ceftriaxone + Doxycycline + Metronidazole

Rx: Antibiotic | Main treatment | Pain and fever

ANTIBIOTIC - choose one

1

CEFTRIAXONE

Antibiotic

Regimen: pid-triple

1 of 3 - GIVE ALL TOGETHER

Strength1000 mg

Forminjection

Adult dose and duration

1 g IM, one part of the three-drug regimen - with doxycycline and metronidazole below, not an alternative to them - Single dose

Paediatric dose

Adolescent regimen identical to adult dose

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Dose source

BASHH UK national guideline for the management of pelvic inflammatory disease, 2018, with the 2019 interim update: "i.m. ceftriaxone 1g single dose followed by oral doxycycline 100mg twice daily plus metronidazole 400mg twice daily for 14 days"

Why

Triple empiric regimen covering N. gonorrhoeae, C. trachomatis, and anaerobic vaginal flora

Cautions
  • 1 g, not 500 mg. BASHH raised the dose in its 2019 interim update; the older 500 mg figure is still widely quoted.
  • MUST complete full 14-day oral course of doxycycline and metronidazole even after rapid symptom improvement.
  • Screen and treat all sexual partners within past 60 days to prevent reinfection.
  • Advise strict avoidance of sexual intercourse until treatment complete and partners treated.
  • Inpatient admission is required if the patient is pregnant, a tubo-ovarian abscess is suspected, or she is unable to tolerate the oral regimen.
Egyptian brands
Egyptian brandManufacturerIndicative price
ZOXIDEL 1 GM PD. FOR I.M. INJ.RAMEDA > DELTA PHARMA22.00 EGP
CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)KAHIRA29.00 EGP
ZOXIDEL 1 GM PD. FOR I.V. INJ.RAMEDA > DELTA PHARMA29.00 EGP
WINTRIAXONE 1 GM PD. FOR I.V INJ.SANOFI48.00 EGP
VOTRIAXONE 1 GM I.M VIALCHEMIPHARM56.00 EGP
OFRAMAX 1 GM I.M. VIALRAMEDA > SUN PHARMA EGYPT LIMITED71.00 EGP
TRIAXONE 1 GM I.M. VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
TRIAXONE 1 GM I.V VIALTABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA106.00 EGP
2

DOXYCYCLINE

Antibiotic

Regimen: pid-triple

2 of 3 - GIVE ALL TOGETHER

Strength100 mg

Formoral.solid

Adult dose and duration

100 mg orally twice daily x 14 days

Paediatric dose

Adolescent regimen identical to the adult dose. Avoid under 8 years except in a severe infection with no alternative.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (doxycycline monograph)

Why

Covers Chlamydia trachomatis, which ceftriaxone does not. Leaving it out treats the gonococcus and misses the commonest cause.

Cautions
  • Contraindicated in pregnancy. PID in a pregnant woman needs hospital admission, not this regimen.
  • Swallow with a full glass of water sitting upright, and not at bedtime - the capsule ulcerates the oesophagus if it lodges.
  • Photosensitivity is common and matters in Egyptian sun; advise cover and sunscreen for the 14 days.
  • Separate from antacids, iron, and dairy by 2 hours, which otherwise bind the dose.
  • The full 14 days must be completed even once the pain settles, or the infection recurs and the tubes scar.
Egyptian brands
Egyptian brandManufacturerIndicative price
FARCODOXIN 100MG 10 CAPS.PHARCO11.00 EGP (1.10/unit)
DOXY M.R.100 MG 10 CAPS.ADWIA12.00 EGP (1.20/unit)
GRANUDOXY 100MG 10 F.C. TAB.GLOBAL NAPI PHARMACEUTICALS > PIERRE FRANCE12.00 EGP (1.20/unit)
DOXYDOX 100 MG 10 CAPS.EIPICO23.00 EGP (2.30/unit)
DOXYMYCIN 100 MG 10 CAPS.EL NILE.30.00 EGP (3.00/unit)
TABOCINE 100MG 10 CAPS.TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA46.00 EGP (4.60/unit)
VIBRAMYCIN 100MG 10 CAPS.PFIZER65.00 EGP (6.50/unit)
3

METRONIDAZOLE

Antibiotic

Regimen: pid-triple

3 of 3 - GIVE ALL TOGETHER

Strength500 mg

Formoral.solid

Adult dose and duration

500 mg orally twice daily - part of the line 1 regimen, and the partner drug for ofloxacin on line 2 x 14 days

Paediatric dose

Adolescent regimen identical to the adult dose.

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (metronidazole monograph)

Why

Covers the anaerobes found in PID, and the bacterial vaginosis that so often accompanies it.

Cautions
  • Treat the sexual partner as well, and abstain until both have finished, or she is reinfected.
  • Metallic taste and nausea are expected and are not a reason to stop early.
  • Strictly avoid alcohol and propylene glycol-containing products during treatment and for 3 days (72 hours) after the last dose - Egyptian National Drug Formulary, Antimicrobial 2023.
Egyptian brands
Egyptian brandManufacturerIndicative price
DUMOZOL 500MG 20 F.C. TABS.MINA PHARM > ALPHARMA-DENMARK7.00 EGP (0.35/unit)
ZOLGUARD 500MG 20 TAB.UNIPHARMA CO. > UNIPHARMA9.00 EGP (0.45/unit)
NITROFECTAZOLE 500 MG 20 F.C. TABS.GYPTO PHARMA10.50 EGP (0.53/unit)
FLAGICURE FORTE 500 MG 20 F.C. TABKAHIRA23.00 EGP (1.15/unit)
TRICHOGYL 500MG 12 F.C.TAB.EL NASR15.00 EGP (1.25/unit)
FLAGELLAT FORTE 500MG 20 F.C.TABS.MUP30.00 EGP (1.50/unit)
GEDAZOLE 500MG 20 TAB.JEDCO INT. CO. FOR PHARMACEUTICALS34.00 EGP (1.70/unit)
METROGYPTON 500 MG 20 F.C. TABS.GYPTO PHARMA34.00 EGP (1.70/unit)
DUMOZOL 125MG/5ML SUSP. 125ML? strength differs? different route - not oral solidMINA PHARM > ALPHARMA-DENMARK5.75 EGP
METROZOLE 125MG/5ML SUSP. 120 ML? strength differs? different route - not oral solidMEMPHIS19.50 EGP
4

OFLOXACIN

Antibiotic

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally twice daily, given with metronidazole 500 mg twice daily - the same metronidazole course shown in the line 1 regimen x 14 days

Paediatric dose

Contraindicated in children under 18 years

Dose source

Egyptian National Drug Formulary - Antimicrobial 2023 (ofloxacin monograph)

Why

Alternative oral regimen where parenteral cephalosporin is contraindicated

Cautions
  • The fluoroquinolone black box warning covers tendinitis, tendon rupture, peripheral neuropathy, and CNS effects.
  • There is high local quinolone resistance in N. gonorrhoeae; use ofloxacin only when cephalosporin allergy is confirmed.
Egyptian brands
Egyptian brandManufacturerIndicative price
GRAND Q 400 MG 10 F.C. TABS.DELTA GRAND PHARMA19.20 EGP (1.92/unit)
OFLOGUIDE 400MG 10 F.C.TAB.BIORIGINAL INTERNATIONAL GROUP PHARMA > GENESIS PHARMACEUTICALS28.80 EGP (2.88/unit)
CEMI-FLOX 400MG 10 F.C. TABS.ARAB CAPS > MASTER MED PHARMA29.00 EGP (2.90/unit)
TARIFLOX 400 MG 10 TABS.BORG45.00 EGP (4.50/unit)
UNITARQIN 400 MG 10 SCORED F.C. TAB.UNIPHARMA CO. > UNIPHARMA38.00 EGP
HEALTHIBACT 400MG 10 SCORED F.C.TABEGPI > HEALTH WELL EGYPT38.50 EGP
5

MOXIFLOXACIN

Antibiotic

2nd line

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg orally once daily as the whole regimen - no ceftriaxone, no doxycycline, no metronidazole alongside it x 14 days

Paediatric dose

Not licensed under 18 years. The guideline states quinolones are not licensed for use in patients aged under 18.

AWaRe

WATCH group - carries resistance cost. Egyptian EML 2025.

Choice

Sourced preference. The entry's rationale names moxifloxacin the only single-drug regimen for pelvic inflammatory disease and the one that covers Mycoplasma genitalium.

Dose source

BASHH 2019 Interim Update - UK National Guideline for the Management of Pelvic Inflammatory Disease (outpatient regimens, second line therapy)

Why

The only single-drug PID regimen, and the one the guideline says covers Mycoplasma genitalium best. It matters here because it is one tablet a day for 14 days against three drugs including an injection, and adherence to the 14-day course is the thing that decides whether the tubes scar.

Cautions
  • Second line, not first. The 2019 update moved the quinolones down because of disabling and potentially permanent tendon, muscle, joint and nervous system effects - the exception is M. genitalium PID where nothing else works.
  • Given alone. It is not added to the ceftriaxone regimen and the metronidazole is not needed with it.
  • Avoid where gonococcal PID is likely - the partner has gonorrhoea, the disease is clinically severe, or there was sexual contact abroad - because of quinolone resistance.
  • Rare but real risk of serious liver reactions; stop for jaundice, dark urine or right upper quadrant pain.
  • QT prolongation - check for other QT-prolonging drugs before writing it.
Egyptian brands
Egyptian brandManufacturerIndicative price
MOXILABACT 400 MG 5 F.C. TABS.KAHIRA30.60 EGP (6.12/unit)
GASTAMOXACINE 400MG 7 F.C. TAB.MEDIZEN PHARMACEUTICAL INDUSTRIES > GAST PHARMA GROUP-EGYPT45.00 EGP (6.43/unit)
MERAMERIX 400MG 5 F.C.TAB.PHARMED HEALTHCARE > ABBOTT LABORATORIES40.50 EGP (8.10/unit)
IDELOX 400MG 10 F.C. TAB.RAMEDA116.00 EGP (11.60/unit)
PRIMOXIZAR 400 MG 5 F.C. TAB.PHARMA CURE PHARMACEUTICALS > PHARMA CURE80.00 EGP (16.00/unit)
MOXIFLOX 400 MG 10 F.C.TABS.EVA PHARMA180.00 EGP (18.00/unit)
MOXAVIDEX 400 MG 10 F.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA184.00 EGP (18.40/unit)
MOXAVIDEX 400 MG 5 F.C.TABS.FUTURE PHARMACEUTICAL INDUSTRIES (FPI) > UTOPIA92.00 EGP (18.40/unit)
MOXIFLOXACIN-EL NILE 400MG/250ML SOL. FOR INF.? strength differs? different route - not oral solidEL NILE.80.50 EGP
MOXITRIX 400MG/250ML SOL. FOR INF.? strength differs? different route - not oral solidARAB CO. FOR MEDICAL PRODUCTS > SPIMACO MISR86.00 EGP

MAIN TREATMENT

6

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Dose source

Pelvic Inflammatory Disease - disease-level clinical article (pelvic-inflammatory-disease-clinical.txt)

Why

Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen.

Cautions
  • RED FLAG - The indications for hospitalization instead of outpatient therapy are pregnancy, failed outpatient treatment, severe illness with vomiting/fever >38.5C, pelvic abscess, or possible need for surgery.
  • RED FLAG - A tubo-ovarian abscess needs surgical drainage, especially if it is large, has ruptured, or the patient is septic.

PAIN AND FEVER - give alongside

7

PARACETAMOL

Pain and fever

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1000 mg three or four times daily, maximum 4000 mg in 24 hours - while the pelvic pain lasts, reviewed at the 72-hour follow-up

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(15 mg/kg 3 or 4 times daily, maximum 60 mg/kg daily. The PID guideline itself is aimed at women aged 16 and over; anyone younger goes down a different pathway. Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

BASHH puts analgesia in General Advice, before the antibiotic regimens, and the woman came in with pain. The guideline says 'appropriate analgesia' without naming a drug, so the drug and dose come from the label.

Cautions
  • First choice for the pain here - no stomach or renal risk and it does not interact with the antibiotics.
  • Check every other product she is taking for paracetamol. Cold and flu sachets are the usual way an accidental overdose happens.
  • Reduce the maximum to 3000 mg/day if she is under 50 kg, malnourished, or has liver disease.
  • Pain that is not settling by 72 hours is a reason to reassess for tubo-ovarian abscess, not a reason to add more analgesia.
  • 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP
8

IBUPROFEN

Pain and fever

add-on - not a substitute

Strength400 mg

Formoral.solid

Adult dose and duration

400 mg up to three times daily with or after food, maximum 1200 mg in 24 hours - while the pelvic pain lasts, reviewed at the 72-hour follow-up

Paediatric dose

20 mg/kg/day [child max 1200 mg]

(20 mg/kg/day in divided doses, three to four times daily with food. Not under 3 months. The PID guideline is aimed at women aged 16 and over.)

Dose by weight
3kg60 mg/day
4kg80 mg/day
5kg100 mg/day
6kg120 mg/day
7kg140 mg/day
8kg160 mg/day
9kg180 mg/day
10kg200 mg/day
11kg220 mg/day
12kg240 mg/day
13kg260 mg/day
14kg280 mg/day
15kg300 mg/day
16kg320 mg/day
17kg340 mg/day
18kg360 mg/day
19kg380 mg/day
20kg400 mg/day
21kg420 mg/day
22kg440 mg/day
23kg460 mg/day
24kg480 mg/day
25kg500 mg/day
26kg520 mg/day
27kg540 mg/day
28kg560 mg/day
29kg580 mg/day
30kg600 mg/day
31kg620 mg/day
32kg640 mg/day
33kg660 mg/day
34kg680 mg/day
35kg700 mg/day
36kg720 mg/day
37kg740 mg/day
38kg760 mg/day
39kg780 mg/day
40kg800 mg/day
41kg820 mg/day
42kg840 mg/day
43kg860 mg/day
44kg880 mg/day
45kg900 mg/day
46kg920 mg/day
47kg940 mg/day
48kg960 mg/day
49kg980 mg/day
50kg1000 mg/day
Choice

Sourced preference. The entry's rationale argues the pain of pelvic inflammatory disease is inflammatory and suits an NSAID better than paracetamol alone.

Dose source

Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560)

Why

The pain of PID is inflammatory and an NSAID suits it better than paracetamol alone. BASHH says 'appropriate analgesia' without naming a drug; the dose is the label's.

Cautions
  • Not if she is or might be pregnant - and pregnancy must be excluded in every suspected PID anyway, because the differential is ectopic.
  • Avoid in asthma, active peptic ulcer and renal impairment.
  • With food, and not on top of another NSAID.
  • Can be given with the paracetamol rather than instead of it if the pain is severe.
Egyptian brands
Egyptian brandManufacturerIndicative price
DAJUANOFEN 400 MG 20 F.C. TABS.COPAD PHARMA5.00 EGP (0.25/unit)
FLABU 400MG 10 F.C.TAB.DELTA PHARMA3.75 EGP (0.38/unit)
NOVA-PROFEN 400MG 30 F.C. TABLETSSANOFI12.75 EGP (0.42/unit)
IBUPROFEN 400 MG 10 TAB.SEDICO6.00 EGP (0.60/unit)
MAFO 400 MG 30 F.C.TABSEIPICO42.00 EGP (1.40/unit)
BRUFEN 400 MG 30 TABS.KAHIRA > ABBOTT LABORATORIES78.00 EGP (2.60/unit)
PROFUSOL 400MG 20 S.G CAPS.EUROPEAN EGYPTIAN PHARM. IND.31.00 EGP
ANALGIPROF 400 MG 25 SACHETSEVA PHARMA37.50 EGP
NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML? strength differs? different route - not oral solidSANOFI2.25 EGP
BRUFEMOL-N SUSP. 60 ML? strength differs? different route - not oral solidARAB DRUG COMPANY (ADCO)4.50 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.