American Board of Internal Medicine (ABIM) Certification Practice Exam

What is included in the oral/IM therapy for pelvic inflammatory disease?

1. Ceftriaxone, 250 mg IM plus metronidazole

2. Ceftriaxone, 250 mg IM plus doxycycline

3. Cefoxitin, 2 g IM plus doxycycline

4. Azithromycin, 1 g PO plus clindamycin

The correct answer is: Ceftriaxone, 250 mg IM plus doxycycline

For the treatment of pelvic inflammatory disease (PID), the recommended oral and intramuscular (IM) therapy includes the combination of ceftriaxone and doxycycline. Ceftriaxone is a broad-spectrum cephalosporin antibiotic that effectively covers Neisseria gonorrhoeae, a common causative organism in PID. Doxycycline, which is a tetracycline antibiotic, provides coverage for Chlamydia trachomatis and other anaerobic bacteria. This combination addresses the polymicrobial nature of PID, ensuring that the most common pathogens are targeted effectively. The dosing of ceftriaxone at 250 mg IM is appropriate for rapid initiation of therapy, and doxycycline is typically administered orally at 100 mg twice a day for an extended duration (usually 14 days). Other options, while they include effective components, do not follow the standard and recommended protocols for PID treatment. For instance, the option that involves cefoxitin and doxycycline does not prioritize the necessary coverage for gonorrhea as effectively as ceftriaxone. Additionally, options with azithromycin or clindamycin do not align with the preferred treatment regimens for PID, as they may lack comprehensive coverage for the common pathogens involved. Thus, the combination