What is the recommended treatment of pelvic inflammatory disease in a nonpregnant patient?

• A. Azithromycin and doxycycline
• B. Ceftriaxone and doxycycline
• C. Ceftriaxone alone
• D. Metronidazole and doxycycline

Answer: (B)

The key idea is that PID treatment must cover the two most common pathogens, Neisseria gonorrhoeae and Chlamydia trachomatis, plus consider anaerobic bacteria in more severe cases. For a nonpregnant patient who can take oral meds, the standard outpatient regimen pairs a cephalosporin that reliably treats gonorrhea with doxycycline to cover chlamydia. Ceftriaxone provides effective gonorrhea coverage, and doxycycline addresses chlamydia (and broadens coverage for other organisms involved in PID). Metronidazole can be added when there is concern for anaerobic infection or more severe disease, but the combination of ceftriaxone and doxycycline remains the core therapy for nonpregnant PID. The other options either miss gonorrhea coverage, miss chlamydia coverage, or omit the necessary dual coverage.