American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred treatment regimen for hospitalized patients with pelvic inflammatory disease?

1. Cefoxitin plus doxycycline

2. Cefotetan plus doxycycline

3. Ciprofloxacin plus metronidazole

4. Azithromycin alone

The correct answer is: Cefotetan plus doxycycline

The preferred treatment regimen for hospitalized patients with pelvic inflammatory disease (PID) is cefotetan plus doxycycline. This combination is effective because it covers the polymicrobial nature of PID, which typically involves a mix of aerobic and anaerobic bacteria, including Neisseria gonorrhoeae and Chlamydia trachomatis, as well as bacterial vaginosis and other organisms. Cefotetan, a second-generation cephalosporin, provides broad-spectrum coverage against the bacteria commonly associated with PID, while doxycycline, a tetracycline antibiotic, targets chlamydial infections and adds further coverage against other potential pathogens. This combination not only treats the infection effectively but also helps reduce the risk of complications, such as abscess formation or chronic pelvic pain, which can arise if the infection is not adequately addressed. In contrast, other options may fall short in terms of effective coverage or necessitating specific conditions that may not align with the typical presentation of PID in hospitalized patients. For instance, cefoxitin is another effective choice, but cefotetan is often favored for its more comprehensive anaerobic coverage. Ciprofloxacin plus metronidazole may not be as appropriate due to the need for better coverage of chlamydia, and az