We evaluated the management of pelvic inflammatory disease (PID) in 2 regional level hospitals and 4 district hospitals of the Central Region of Ghana. We retrospectively reviewed 208 case notes of inpatients clinically diagnosed with PID and interviewed 25 clinicians at these hospitals. Overall, 20 antibiotics were prescribed in 62 different regimens. Between 9 and 26 antibiotic regimens were prescribed in each hospital. Metronidazole, gentamicin, amoxycillin, ampicillin, benzylpenicillin and tetracycline were frequently prescribed while the recommended anti-gonococcal antibiotics, ciprofloxacin and ceftriaxone, were rarely prescribed. The commonest regimens were prescribed for a shorter duration than recommended. Condom promotion, partner notification and management were scarcely or never undertaken. Fifty-six per cent of clinicians had never seen the national treatment guidelines