UTI: urinary tract infection; MDR: multidrug-resistant; ESBL: extended-spectrum beta-lactamase; TMP-SMX: trimethoprim-sulfamethoxazole; IV: intravenous; IM: intramuscular.
* We consider individuals who have pyuria with only cystitis symptoms to have acute simple cystitis and manage them differently. Fever or systemic symptoms suggest that infection has extended beyond the bladder and is a complicated UTI. The possibility of prostatitis should also be considered in males with urinary and systemic symptoms. The temperature threshold used to determine whether to treat a patient as simple cystitis or complicated UTI is not well defined and should take into account baseline temperature, other potential contributors to an elevated temperature, and the risk of poor outcomes should empiric antimicrobial therapy be inappropriate.
¶ This includes a single antimicrobial dose given for prophylaxis prior to prostate procedures.
Δ Appropriate oral agents to treat complicated UTI include levofloxacin (5 to 7 days), ciprofloxacin (for 5 to 7 days), and TMP-SMX (for 7 to 10 days). Beta-lactams (for 7 to 10 days) are appropriate if susceptibility is documented and other agents are not feasible.
◊ A longer duration of therapy may be warranted in patients who have a nidus of infection that cannot be removed. Patients who have worsening symptoms following initiation of antimicrobials, persistent symptoms after 48 to 72 hours of appropriate antimicrobial therapy, or recurrent symptoms within a few weeks of treatment should have additional evaluation including abdominal/pelvic imaging, if not already performed) for factors that might be compromising clinical response.
§ Patients should be advised about the uncommon but potentially serious musculoskeletal and neurologic adverse effects associated with fluoroquinolones.
¥ Of the options listed, ceftriaxone is typically the preferred agent. Ertapenem is an alternative for patients with allergy or expected resistance to ceftriaxone, and aminoglycosides are reserved for patients who cannot use either.
‡ For outpatients who are more ill or are at risk for more severe illness, continuing the parenteral therapy pending culture results is also reasonable.Do you want to add Medilib to your home screen?