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First choice * [1-4] Cefoxitin and 2 g IV every 6 hours Doxycycline 100 mg orally or IV every 12 hours Cefotetan and 2 g IV every 12 hours Doxycycline 100 mg orally or IV every 12 hours Clindamycin and 900 mg IV every 8 hours Gentamicin • 2 mg/kg loading dose then 1.5 mg/kg every 8 hours IV or IM Ampicillin and 2 g IV every 6 hours Clindamycin and 900 mg IV every 8 hours Gentamicin (3-antibiotic regimen) • 2 mg/kg loading dose then 1.5 mg/kg every 8 hours IV or IM Ampicillin-sulbactam and 3 g IV every 6 hours Δ Doxycycline 100 mg orally or IV every 12 hours

Outpatient oral regimens ( only as continuation of therapy in select patients) ◊§ Levofloxacin or Ofloxacin and 500 mg orally once daily Metronidazole 500 mg orally twice daily Amoxicillin-clavulanate XR 2000 mg extended release orally twice daily * Antibiotic doses should be adjusted appropriately for patients with renal insufficiency or other dose-related consideration. • Alternatively gentamicin may be given 3 to 5 mg/kg IV once per day. Δ 3 g ampicillin-sulbactam is equivalent to 2 g ampicillin with 1 gram sulbactam. ◊ There are insufficient high quality data about this agent or regimen; coverage is theoretic. § In select patients in whom clinical improvement has been clearly documented, continuation of therapy as an outpatient may be appropriate. Direct communication with the patient and a plan for follow-up must also be confirmed. References: Workowski KA, Berman S. Centers for Disease Control and Prevention. Sexually transmitted disease treatment guidelines, 2010. MMWR Recomm Rep 2010; 59:1. Landers DV, Sweet RL. Tubo-ovarian abscess: contemporary approach to management. Rev Infect Dis 1983; 5:876. Reed SD, Landers DV, Sweet RL. Am J Obstet Gynecol 1991; 164:1556. Ginsburg DS, Stern JL, Hamod KA, et al. Am J Obstet Gynecol 1980; 138:1055.