UTI

Question 1

1st line options for Uncomplicated Cystitis in Women (community-acquired)

Answer 1

PO co-trimoxazole 800/160 mg bid x 3d

PO nitrofurantoin 50 mg qid x 5d

PO fosfomycin 3 g single dose

Question 2

Alternative tx for uncomplicated cystitis in women

Answer 2

PO beta-lactams x 3-7 days

• PO cefuroxime 250 mg bid
• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg bid

PO fluoroquinolones x 3 days:

• PO ciprofloxacin 250 mg bid
• PO levofloxacin 250 mg daily

Question 3

Treatment for complicated cystitis in women

Answer 3

Co trimoxazole 960mg BD x 7 days

Beta lactams x 10-14 days

Fosfomycin 3g EOD x 3 doses

Question 4

First line treatment for Community-acquired Pyelonephritis in women

Answer 4

PO ciprofloxacin 500 mg twice daily x 7 days

PO levofloxacin 750 mg daily x 5 days

Question 5

Alternative treatment for community acquired pyelonephritis in women?

Answer 5

PO co-trimoxazole 160/800 mg BD x 14 days

PO Beta-lactam x 10-14 days:

• PO cephalexin 500 mg bid
• PO amoxicillin-clavulanate 625 mg tds

Question 6

For severely ill patients with pyelonephritis, what IV therapy can we give?

Answer 6

(IV ciprofloxacin 400mg bid

IV cefazolin 1g q8h

IV amoxi-clav 1.2g q8h)

and/or [IV/IM gentamicin 5mg/kg]

Switch to oral when patient improves or able to take orally

Question 7

Community acquired UTI in men?

Answer 7

For cystitis (with concern for prostatitis) or pyelonephritis in men:

• PO ciprofloxacin 500 mg twice daily
• PO co-trimoxazole 800/160 mg twice-daily

X 10-14 days. Longer duration if prostatitis is confirmed (6 weeks).

Question 8

If men has cystitis with no concern for prostatitis?

Answer 8

Cotrimoxazole 960mg BD x 7 days

Beta lactams:

PO cefuroxime 250 mg bid

PO cephalexin 500 mg bid

PO amoxicillin-clavulanate 625 mg bid

X 10-14 days

Fosfomycin

3 g EOD x 3 doses

Question 9

Treatment for Nosocomial/ Healthcare- associated Pyelonephritis?

Answer 9

IV imipenem 500mg q6h or IV meropenem 1g q8h

IV cefepime 2g q12h +/- IV amikacin 15mg/kg/d

X 7-14 days

For less sick patients:

PO levofloxacin 750mg OD

PO ciprofloxacin 500mg bid

X 7-14 days

Question 10

CaUTI treatment options?

Answer 10

IV imipenem 500mg q6H or IV meropenem 1g q8h

IV cefepime 2g q12H +/- IV amikacin 15mg/kg (1 dose)

X 7 days

For mild CA UTI:

PO/ IV levofloxacin 750mg x 5d

PO Co-trimoxazole 960mg bid x 3d

Question 11

Abx to avoid in pregnancy

Answer 11

Fluroquinolones, e.g. ciprofloxacin due to arthropathy

Co trimoxazole in first and third trimester due to neural tube defect & kernicterus & hemolysis if G6PD deficient

Nitrofurantoin at term bc hemolysis if G6PD deficient

Aminoglycosides due to nerve toxicity

Question 12

What abx to use in pregnancy

Answer 12

Beta lactams x 10-14 days as complicated cystitis