Adult Outpatients: Urinary Tract Infections: Cystitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Uncomplicated Cystitis

Women

Enterobacteriaceae (E. coli)

S. saprophyticus (Coagulase negative staphylococcus) (4%)

Nitrofurantoin 100 mg PO BID x 5-7 days – contraindicated in renal insufficiency (CrCl < 60 ml/min)

OR

TMP/SMX 1 DS tablet PO BID x 3 days (if no previous antibiotic therapy)

OR

Fosfomycin 3 g PO x1 dose

Reserve for patients at highest risk of failure (selection for resistant isolates):

Ciprofloxacin 500 mg PO BID x 3 days

OR

Levofloxacin 500 mg PO daily x 3 days

 

Reserve for patients with history of resistant organisms or therapeutic failure (less effective):

Cephalexin 500 mg PO QID x 7 days

OR

Cefpodoxime 200 mg PO BID x 7 days

IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20%.

Susceptibility data:

UCSF

SFGH

VASF

Nitrofurantoin is contraindicated in renal insufficiency (CrCl <60 ml/min).

Fosfomycin is not on the SFGH formulary.

Recurrent Cystitis

Women

(3 or more episodes/year)

Enterobacteriaceae (E. coli)

S. saprophyticus (Coagulase negative staphylococcus) (4%)

Prophylaxis:

Either self administration if symptoms occur or prophylactic post-coital antibiotics

 

Post menopausal: topical estrogen

Antibiotic choice should be based on susceptibility results of previous culture. 

 

 

Asymptomatic bacteriuria

E.coli

Klebsiella

Enterococcus

No treatment required*   

Pyuria is not an indication for treatment.

 

*Exceptions: pregnant women, patients having traumatic urologic procedures.