Urinary Tract Infections (UTIs)
Diagnosis
Uncomplicated vs complicated UTI
- Uncomplicated: UTI in a patient with a normal GU tract and no recent instrumentation
- Complicated: UTI in the presence of an anatomic abnormality, functional abnormality, recent GU instrumentation, or foreign material (e.g., ureteral stent)
Common Caustive Organisms
E. coli, Proteus spp., Klebsiella spp. Pseudomonas spp. (if at least 1 risk factor^ present)
^Pseudomonal risk factors include: hospitalization within the last 30 days AND received IV antibiotics, history of prior pseudomonal infection, immunocompromised (uncontrolled HIV, transplant, etc.)
Empiric Outpatient UTI Treatment
|
Diagnosis |
Preferred Treatment |
Duration |
|
Uncomplicated cystitis |
Cephalexin 500 mg PO q12h |
7 days |
|
Nitrofurantoin 100 mg PO q12h |
Male: 7 days Female: 5 days |
|
|
Ciprofloxacin 500 mg PO q12h (pseudomonas risk^) |
7 days |
|
|
CAUTI |
Cefpodoxime 200 mg PO q12h |
Prompt symptom resolution: 7 days Delayed response: 10 - 14 days |
|
Sulfamethoxazole-trimethoprim 1 DS PO q12h |
||
|
Ciprofloxacin 500 mg PO q12h (pseudomonas risk^) |
||
|
Pyelonephritis or complicated UTI |
Ceftriaxone 1 gm x1 IM, then Cefpodoxime 200 mg PO q12h |
10 – 14 days |
|
Sulfamethoxazole-trimethoprim 1 DS PO q12h |
10 - 14 days |
|
|
Ciprofloxacin 500 mg PO q12h (pseudomonas risk^) |
7 days |
|
|
Epididymitis |
Levofloxacin* 500 mg PO daily |
10 days |
|
If concerned about sexually transmitted chlamydia and gonorrhea ADD: Doxycycline 100 mg PO BID x7 days AND one-time dose of IM ceftriaxone: Total body weight < 150 kg: ceftriaxone 500 mg IM x1 Total body weight > 150 kg: ceftriaxone 1000 mg IM x1 |
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|
Acute bacterial prostatitis |
Sulfamethoxazole-trimethoprim 1 DS PO q12h |
14 days |
|
Ciprofloxacin 500 mg PO q12h |
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|
Chronic prostatitis |
Consider consulting urology service |
|
Empiric Inpatient UTI Treatment
|
Diagnosis |
Preferred Treatment |
Duration |
|
Community acquired uncomplicated cystitis |
Cephalexin 500 mg PO q12h |
7 days |
|
Nitrofurantoin 100 mg PO q12h |
Male: 7 days Female: 5 days |
|
|
Ciprofloxacin* 500 mg PO q12h (pseudomonas risk^) |
7 days |
|
|
Community acquired pyelonephritis or complicated UTI |
Ceftriaxone 1 gm IV q24h |
All IV or step down to PO fluroquinolone: 7 days
PO Step down to beta-lactam or sulfa-trimethoprim: 10 - 14 days |
|
Cefepime* 2 gm IV q12h (pseudomonas risk^) |
||
|
Healthcare associated complicated or uncomplicated UTI |
Ertapenem 1 gm IV q24h |
Prompt symptom resolution: 7 days Delayed response: 10 - 14 days |
|
Cefepime* 2 gm IV q12h (pseudomonas risk^) |
||
|
CAUTI |
Ceftriaxone 1 gm IV q24h |
Prompt symptom resolution: 7 days Delayed response: 10 - 14 days |
|
Cefepime* 2 gm IV q12h (pseudomonas risk^) |
||
|
Acute bacterial Prostatitis |
Sulfamethoxazole-trimethoprim 1 DS PO q12h |
14 days |
|
Ciprofloxacin* 500 mg PO q12h |
*Contact ASP Pharmacist (preferred) or ID fellow to approve use outside of ICU
^Pseudomonal risk factors include hospitalization within the last 30 days AND received IV antibiotics, history of prior pseudomonal infection, immunocompromised (uncontrolled HIV, transplant, etc.)
Clinical Pearls
- When results are available, treatment should be tailored based on culture data
- Asymptomatic bacteriuria does not require antibiotic therapy for most patients. Antibiotics are only indicated for:
- Pregnancy: cystitis treatment
- Urological procedure: 1 dose prior to procedure and 1 to 2 doses after
- Catheter associated UTIs (CAUTI) require change in catheter and then may be treated based on site of infection
- Lower cefepime doses are used to treat Pseudomonal UTIs compared to systemic pseudomonal infections due to high urinary concentration (85% of unchanged drug excreted via urine)
References:
1. Gupta, Kalpana, et al. "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases." Clinical infectious diseases 52.5 (2011): e103-e120.
2. Hooton, Thomas M., et al. "Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America." Clinical infectious diseases 50.5 (2010): 625-663.