| 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: https://idmp.ucsf.edu/content/sexually-transmitted-infections |
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 |