UTI Flashcards
First line antibiotic - narrow spectrum for uncomplicated cystitis
PO cotrimoxazole 960mg BD 3 days
PO nitrofurantoin 50mg QID 5 days
First line antibiotic - broad spectrum for uncomplicated cystitis
PO fosfomycin 3g single dose
Alternative antibiotic - uncomplicated cystitis
PO cephalexin 500mg BD 3-7 days
PO Cefuroxime 250mg BD 3-7 days
PO Augmentin 625mg BD 3-7 days
PO ciprofloxacin 250mg BD 3 days
PO levofloxacin 250mg OD 3 days
Choice of Antibiotic - complicated cystitis in women/men without concern for prostatitis
PO cotrimoxazole 960mg BD 7 days PO cephalexin 500mg BD 10-14 days PO cefuroxime 250mg BD 10-14 days PO Augmentin 625mg BD 10-14 days PO Fosfomycin 3mg EOD for 3 doses
First line antibiotics for community acquired pyelonephritis in women - oral options
PO ciprofloxacin 500mg BD 7 days PO levofloxacin 750mg OD 5 days PO cotrimoxazole 960mg BD 14 days PO cephalexin 500mg BD 10-14 days PO Augmentin 625mg TDS 10-14 days
Antibiotics choice for community acquired pyelonephritis (severe - IV options)
IV Ciprofloxacin 400mg BD
IV Cefazolin 1g q8h
IV Augmentin 1.2g q8h +/- Gentamicin 5mg/kg
Use until patient gets better then de-escalate (probably within 2-3 days)
Antibiotics choice for UTI (Cystitis) in men with concern for prostatitis
PO ciprofloxacin 500mg BD 10-14 days
PO cotrimoxazole 960mg BD 10-14 days
if confirmed prostatitis need treat ~6 weeks. If no prostatitis can streamline to beta-lactams.
Nosocomial/ healthcare associated pyelonephritis (Higher risk for resistant organisms)
Onset of UTI > 48h post admission
IV cefepime 2g q12h +/- IV amikacin 15mg/kg/day: 7 - 14 days
IV imipenem 500mg (+ cilastatin) q6h for 7-14 days
IV meropenem 1g q8h for 7-14 days
PO levofloxacin 750mg OD (Less sick) for 7-14 days
PO ciprofloxacin 500mg BD (Less sick) for 7-14 days
If patient becomes afebrile in 3 days, can treat for 7 days.
Catheter associated or non-catheter associated asymptomatic bacteriuria treatment recommended for who?
Treatment of asymptomatic bacteriuria not recommended UNLESS prior to traumatic urological procedures, pregnant women, young children.
CA-UTI is usually benign, true or false?
True
When will antibiotics be indicated for CA-UTI?
When there is presence of symptomatic infection i.e fever, rigors, altered mental status, malaise, lethargy with no other identified cause, flank pain, renal punch positive, acute hematuria, pelvic discomfort.
When patient stable with low grade fever, can hold the antibiotics first.
Empiric antibiotics for CA-UTI
IV imipenem 500mg (+ cilastatin) q6h
IV meropenem 1g q8h
IV cefepime 2g q12h +/- amikacin 15mg/kg/dose
PO or IV levofloxacin 750mg for 5 days (mild)
PO cotrimoxazole 960mg BD for 3 days - for women 65 years and less with CA-UTI without upper urinary tract symptoms after removal of catheter.
Duration of treatment is 7 to 14 days
UTI in pregnancy, which drug to avoid
Cotrimoxazole
Nitrofurantoin
Aminoglycosides
Ciprofloxacin/Levofloxacin
UTI in pregnancy, drug of choice + treatment duration
beta lactams are the drug of choice
Treatment for 7 days for asymptomatic bacteriuria and cystitis
Treatment for 14 days for pyelonephritis
