Urinary Tract Infection (UTI)
| Diagnosis | Common Pathogens | Drug(s) of First Choice | Alternative Drug(s) | Comments | Expected Duration | |
|---|---|---|---|---|---|---|
| Acute prostatitis | Enterobacteriaceae (E. coli) N. gonorrhoeae C. trachomatis | OR If high risk for sexually transmitted infection, refer to link below: | Antibiotic penetration in the acute inflammatory state is adequate for most antibiotics Test for N. gonorrhoeae and C. trachomatis in sexually active patients and treat as indicated | 2-4 weeks Cultures should be obtained and definitive therapy should be based on sensitivities | ||
| Chronic prostatitis | Enterobacterales spp (E. coli) | OR | Few drugs penetrate non-inflamed prostate Fluoroquinolones and trimethoprim/sulfamethoxazole adequately penetrate in non-inflamed state Test for N. gonorrhoeae and C. trachomatis in sexually active patients Consider urologic evaluation *Cultures should be obtained and definitive therapy should be based on sensitivities. | 6-8 weeks | ||
| Asymptomatic bacteriuria | Enterobacterales spp Enterococcus spp | No antibiotic treatment required, replace or remove urinary catheter | Pyuria, foul smelling or cloudy urine alone are not indications for treatment Exceptions: pregnant women, patients having traumatic urologic procedures, ANC < 500, recent renal transplant (3 months) | 0 days | ||
| Catheter-associated candiduria | Candida spp | Treatment not generally required | Pyuria is not an indication for treatment | 0 days | ||
| Community-acquired pyelonephritis/complicated UTI, hospitalized patient | Enterobacterales spp (e.g. E. coli, Proteus) | OR (if most recent microbiology suggesting resistance or for hemodynamically unstable patients) | Switch to oral therapy when susceptibilities known and patient stable Consider prostatitis in males with UTI and fever | 7 days | ||
| Community-acquired pyelonephritis/complicated UTI, outpatient | Enterobacterales spp (E. coli) Enterococcus spp | Ceftriaxone X 1 dose Followed by TMP/SMX (trimethoprim/sulfamethoxazole) OR Ciprofloxacin (preferred as monotherapy if ceftriaxone not available) | Ceftriaxone X 1 dose Followed by one of the agents below: OR oral β-lactam (amoxicillin/clavulanate, cefuroxime, cefpodoxime) | Trimethoprim-sulfamethoxazole is preferred if organism is susceptible
Consider prostatitis in males with UTI and fever Urinalysis and urine culture should be performed and therapy adjusted based on culture and sensitivity | 7 days
| |
| Healthcare onset UTI (including catheter associated) | Enterobacterales spp (e.g. E. coli, Proteus) P. aeruginosa (less common) | OR Ertapenem (if most recent microbiology suggesting resistance or if hemodynamically unstable)
| For severe PCN allergy: Aztreonam | Criteria: signs and symptoms compatible with a UTI, no other identified source of infection, & ≥ 100,000 cfu of ≥ 1 bacterial species on urine culture Pyuria alone is not an indication for treatment. A negative urinalysis suggests an alternative source of infection Remove catheter if possible. Switch to oral therapy when susceptibilities known and patient stable Consider prostatitis in males with UTI and fever | 7 days | |
| Uncomplicated Cystitis, Women | Enterobacterales spp (E. coli) Staph. saprophyticus (Coagulase negative staphylococcus) (4%) | Nitrofurantoin 100 mg PO BID x 5 days (avoid if CrCl < 30 mL/min) | Cephalexin 500 mg PO BID x 5-7 days Reserve for patients at highest risk of failure (selection for resistant isolates): Ciprofloxacin 500mg PO q12h x 3 days Trimethoprim/ Sulfamethoxazole 1 DS PO BID x 3 days (if no previous antibiotic therapy) | Asymptomatic bacteriuria and/or pyuria are not indications for treatment Exceptions: pregnant women, patients having traumatic urologic procedures, ANC < 500, recent renal transplant (3 months) IDSA guidelines state Trimethoprim/ Sulfamethoxazole is appropriate if resistance rates do not exceed 20% In patients with recurrent UTIs, review recent microbiology to help determine empirical therapy | 3-7 days depending on antibiotic chosen |