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Alternative Regimen

If cephalosporin allergy or history of penicillin anaphylaxis:

Inpatient

  • Clindamycin 13 mg/kg (max 900 mg) IV q 8 hrs - and -
  • Gentamicin
    • Preferred: 3 ‐ 5 mg/kg IV daily - or -
    • Alternative: 2 mg/kg IV as a loading dose followed by 1.5 mg/kg IV q 8 hrs


Inpatient transitioning to oral therapy

  • Clindamycin 13 mg/kg (max 600 mg) PO q 8 hrs - or -

  • Doxycycline 2.2 mg/kg (max 100 mg) PO q 12 hrs 

Total duration for inpatient antibiotics is 14 days

Outpatient

  • Levofloxacin 10 mg/kg (max 500 mg) PO 1x/day for 14 days - and -

  • Metronidazole

    • ≥ 45 kg: 500 mg PO BID x 14 days

    • < 45 kg: 10 - 13 mg/kg (max 500 mg/dose) PO TID x 14 days


If tubo-ovarian abscess is present:

  • Clindamycin 13 mg/kg (max 600 mg) PO q 8 hrs TID for 14 days - and -

  • Doxycycline 2.2 mg/kg (max 100 mg) PO BID for 14 days
    -or-

  • Doxycycline 2.2 mg/kg (max 100 mg) PO BID for 14 days - and -

  • Metronidazole 500 mg PO 2x/day for 14 days

    • ≥ 45 kg: 500 mg PO BID x 14 days

    • < 45 kg: 10 - 13 mg/kg (max 500 mg/dose) PO BID x 14 days

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.

Children's Mercy Kansas City
Health Care Providers
Evidence Based Practice / Clinical Pathways
Clinical Practice Guidelines, Care Process Models, and Enhanced Recovery After Surgery Pathways
Pelvic Inflammatory Disease
Alternative Regimen