VASF Urinary Tract Infections (UTI) Treatment Guidelines

Modified Date: 
November 29, 2023

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

Acute bacterial prostatitis

Sulfamethoxazole-trimethoprim 1 DS PO q12h

14 days

Ciprofloxacin 500 mg PO q12h

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.