American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the parenteral therapy regimen for pelvic inflammatory disease?

1. Cefotetan, 2 g every 6 hours plus azithromycin

2. Cefotetan, 2 g every 12 hours plus doxycycline

3. Clindamycin, 900 mg every 8 hours plus azithromycin

4. Metronidazole, 500 mg every 12 hours plus ciprofloxacin

The correct answer is: Cefotetan, 2 g every 12 hours plus doxycycline

The parenteral therapy regimen for pelvic inflammatory disease (PID) commonly includes the combination of cefotetan and doxycycline. Cefotetan is a second-generation cephalosporin that provides broad coverage against the typical pathogens associated with PID, namely Neisseria gonorrhoeae and Chlamydia trachomatis, as well as other anaerobic bacteria. The dosing of cefotetan at 2 g every 12 hours ensures adequate therapeutic levels to combat the infection. Doxycycline complements this by providing additional coverage against Chlamydia, which is a frequently implicated organism in PID. Administering doxycycline at 100 mg every 12 hours (not specified in the choice but standard practice) ensures that patients receive effective treatment for the bacterial changes that often accompany PID. This combination has been established in clinical guidelines as both effective and well-tolerated, making it a preferred choice for parenteral therapy in the management of moderate to severe cases of PID. The regimen is structured to address the polymicrobial nature of pelvic infections effectively. Other regimens listed could be suitable for different clinical scenarios but do not align as closely with the standard treatment protocols for PID. For example, while cefotetan and azithromycin is a potent