Acute uncomplicated cystitis in young women

A. Sexually active young women are most at risk for UTIs.

B. Approximately 90 percent of uncomplicated cystitis episodes are caused by Escherichia coli, 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent or less are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin and, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95 percent).

C. Patients should be evaluated for pyuria by urinalysis (wet mount examination of spun urine) or a dipstick test for leukocyte esterase.

Urinary Tract Infections in Adults

Category

Diagnostic criteria

First-line therapy

Comments

Acute uncomplicated cystitis

Urinalysis for pyuria and hematuria (culture not required)

TMP-SMX

DS (Bactrim,

Septra)

Trimethoprim

(Proloprim)

Ciprofloxacin

(Cipro)

Ofloxacin

(Floxin)

Three-day course is best Quinolones may be used in areas of TMP-SMX resistance or in patients who cannot tolerate TMP-SMX

Recurrent cystitis in young women

Symptoms and a urine culture with a bacterial count of more than 100 CFU per mL of urine

If the patient has more than three cystitis episodes per year, treat prophylacti-cally with postcoital, patient- directed or continuous daily therapy

Repeat therapy for seven to 10 days based on culture results and then use prophylactic therapy

Acute cystitis in young men

Urine culture with a bacterial count of 1,000 to 10,000 CFU per mL of urine

Same as for acute uncomplicated cystitis

Treat for seven to 10 days

Acute un-complicated pyelonephritis

Urine culture with a bacterial count of 100,000 CFU per mL of urine

If gram-negativ e organism, oral fluoroquinolo ne

If gram-positive organism, amoxicillin If parenteral administration is required, ceftri-axone (Rocephin) or a fluoroquino-

lone

Enterococcu s species, add oral or IV amoxicillin

Switch from IV to oral administration when the patient is able to take medication by mouth; complete a 14-day course

Complicated urinary tract infection

Urine culture with a bacterial count of more than 10,000 CFU per mL of urine

If gram-negativ e organism, oral fluoroquinolo ne

Enterococcu s species, ampicillin or amoxicillin with or without gent-amicin (Garamycin)

Treat for 10 to 14 days

Catheter-a ssociated urinary tract infection

Symptoms and a urine culture with a bacterial count of more than 100 CFU per mL of urine

If gram-negativ e organism, a fluoro-quinolone If gram-positive organism, ampicillin or amoxicillin plus genta-micin

Remove catheter if possible, and treat for seven to 10 days

For patients with long-term catheters and symptoms, treat for five to seven days

Antibiotic Therapy for Urinary Tract Infections

Diagnostic group

Duration of therapy

Empiric options

Acute uncomplicated urinary tract infections in women

Three days

Trimethoprim-sulfamethoxazole (Bactrim DS), one double-strength tablet PO twice daily Trimethoprim (Proloprim), 100 mg

PO twice daily Norfloxacin (Noroxin), 400 mg twice daily Ciprofloxacin (Cipro), 250 mg twice daily

Lomefloxacin (Maxaquin), 400 mg per day

Ofloxacin (Floxin), 200 mg twice daily

Enoxacin (Penetrex), 200 mg twice daily

Sparfloxacin (Zagam), 400 mg as initial dose, then 200 mg per day Levofloxacin (Levaquin), 250 mg per day

Nitrofurantoin (Macrodantin), 100

mg four times daily Cefpodoxime (Vantin), 100 mg twice daily Cefixime (Suprax), 400 mg per day

Amoxicillin-clavulanate(Augmenti n), 500 mg twice daily

Acute un-complicated pyelonephr itis

14 days

Trimethoprim-sulfamethoxazole DS, one double-strength tablet PO twice daily Ciprofloxacin (Cipro), 500 mg twice daily

Levofloxacin (Maxaquin), 250 mg per day

Enoxacin (Penetrex), 400 mg twice daily

Sparfloxacin (Zagam) 400 mg initial dose, then 200 mg per day 104.50

Ofloxacin (Floxin), 400 mg twice daily

Cefpodoxime (Vantin), 200 mg twice daily

Cefixime (Suprax), 400 mg per day

Up to 3 days

Trimethoprim-sulfamethoxazole

(Bactrim) 160/800 IV twice daily Ceftriaxone (Rocephin), 1 g IV per day

Ciprofloxacin (Cipro), 400 mg twice daily

Ofloxacin (Floxin), 400 mg twice daily

Levofloxacin (Penetrex), 250 mg per day

Aztreonam (Azactam), 1 g three times daily Gentamicin (Garamycin), 3 mg per kg per day in 3 divided doses every 8 hours

Complicated urinary tract infections

14 days

Fluoroquinolones PO

Up to 3 days

Ampicillin, 1 g IV every six hours, and gentamicin, 3 mg per kg per day

Urinary tract infections in young men

Seven days

Trimethoprim-sulfamethoxazole, one double-strength tablet PO twice daily Fluoroquinolones

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