Urinary tract infection: antibiotic therapy recommendations

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Urinary tract infections

Possible therapeutic alternatives

UTI: uncomplicated cystitis - urethritis

Common pathogens

BactrimDS orally twice daily for 3 days or

Ciprofloxacin 250mg orally twice daily for 3 days or Norfloxacin 400mg orally twice daily for 3 days or Ofloxacin 200mg orally twice daily for 3 days or Levofloxacin 250mg orally once daily for 3 days.

Augmentin 875mg orally twice daily or 500mg po tid or keflex or Velosef 250-500mg orally four times daily.

Recurrent cystitis(> 3 episodes per year)

Common pathogens

Treat infection with one of the regimens above, then start long term maintenance therapy with Bactrim single-strength one tablet once daily.

Complicated UTI: catheter in place, obstruction etc.

Common pathogens

[Ampicillin 1 gram IV every 6 hours + Gentamycin IV] or

Ciprofloxacin 200-400mg IV every 12 hours or Levofloxacin 250 to 500mg IV qd or

Piperacillin-tazobactam 3.375 grams IV every 6 hours or

Imipenem 500mg IV q6h

Gonococcal urethritis

Neisseria gonorrhoeae

Cefixime 400 mg PO x 1 PLUS [ Azithromycin 1 g PO x 1 OR Doxycycline 100 mg PO bid x 7 d if chlamydia infection has not been ruled out]

Ceftriaxone 125 mg IM x 1 PLUS [Azithromycin 1 g PO x 1 OR Doxycycline 100 mg PO bid x 7 d if chlamydia infection has not been ruled out]

Ciprofloxacin 500 mg PO x1 PLUS [Azithromycin 1 g PO x 1 OR Doxycycline 100 mg PO bid x 7 d if chlamydia infection has not been ruled out]

Levofloxacin 250 mg PO x 1 PLUS [Azithromycin 1 g PO x 1 OR Doxycycline 100 mg PO bid x 7d if chlamydia infection has not been ruled out]

non-gonococcal urethritis

Chlamydia trachomatis

Azithromycin 1 g PO x 1

Doxycycline 100 mg PO bid x 7d

Recurrent or persistent urethritis

Common pathogens

Metronidazole 2 grams po once + Erythromycin base 500 mg PO qid x 7 days

Metronidazole 2 grams PO once + erythromycin ethylsuccinate 800 mg PO qid x 7 days

Acute cystitis
(Bladder infection)
Cross-section

Antimicrobial Series
References

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Diabetes Metab Res Rev. 2000 Sep-Oct;16 Suppl 1:S42-6.

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