A. A complicated UTI is one that occurs because of enlargement of the prostate gland, blockages, or the presence of resistant bacteria.
B. Accurate urine culture and susceptibility are necessary. Treatment consists of an oral fluoroquinolone. In patients who require hospitalization, parenteral administration of ceftazidime (Fortaz) or cefoperazone (Cefobid), cefepime (Maxipime), aztreonam (Azactam), imipenem-cilastatin (Primaxin) or the combination of an antipseudomonal penicillin (ticarcillin [Ticar], mezlocillin [Mezlin], piperacillin [Pipracil]) with an aminoglycoside.
C. Enterococci are frequently encountered uropathogens in complicated UTIs. In areas in which vancomycin-resistant Enterococcus faecium is prevalent, quinupristin-dalfopristin (Synercid) may be useful.
D. Patients with complicated UTIs require at least a 10- to 14-day course of therapy. Follow-up urine cultures should be performed within 10 to 14 days after treatment.
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