Wednesday, June 12, 2024
HomeInfectious DiseasesUrinary Tract Infection Organism-Specific Therapy

Urinary Tract Infection Organism-Specific Therapy

Specific Organisms and Therapeutic Regimens

Organism-specific therapy for urinary tract infection (UTI) should be based on in vitro susceptibility data from a patient-specific isolate, as wide geographic variability exists.
The narrowest-spectrum drug that retains appropriate susceptibility is recommended, even if multiple agents including the initial empiric choice are found to have susceptibility.

In addition, fluoroquinolones, such as ciprofloxacin and levofloxacin, while highly effective for uncomplicated infection, have added risks, including the propensity to select for subsequent infection with more resistant organisms, and thus should be reserved for other uses.

Uncomplicated urinary tract infections

Escherichia coli (trimethoprim/sulfamethoxazole sensitive)

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 3 days or

Trimethoprim 100 mg PO BID for 3 days or

Nitrofurantoin macrocrystals 50-100 mg PO QID for 5 days or

Nitrofurantoin sustained-release 100 mg PO BID for 5 days or

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days or

Levofloxacin 250 mg PO daily for 3 days

Escherichia coli (trimethoprim/sulfamethoxazole resistant)

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days or

Levofloxacin 250 mg PO q24h for 3 days or

Nitrofurantoin macrocrystals 50-100 mg PO QID for 7 days or

Nitrofurantoin sustained-release 100 mg PO BID for 7 days

Staphylococcus saprophyticus

Cephalexin 500 mg PO QID for 7 days or

Amoxicillin-clavulanate 875-125 mg PO BID for 7 days or

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days or

Levofloxacin 250 mg PO daily for 3 days

Klebsiella species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 3 days or

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days or

Levofloxacin 250 mg PO daily for 3 days or

Nitrofurantoin macrocrystals 50-100 mg PO QID for 7 days or

Nitrofurantoin sustained-release 100 mg PO BID for 7 days

Proteus species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 3 days or

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days

Enterobacteriaceae species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 3 days or

Nitrofurantoin macrocrystals 50-100 mg PO QID for 7 days or

Nitrofurantoin sustained-release 100 mg PO BID for 7 days or

Ciprofloxacin 250 mg PO BID or extended-release 500 mg PO daily for 3 days or

Levofloxacin 250 mg PO daily for 3 days

Pseudomonas aeruginosa

Ciprofloxacin 500-750 mg PO BID for 3 days

Discuss alternatives with an infectious disease specialist

Candida species

Fluconazole 200-mg loading dose followed by 100 mg PO daily for at least 4 days

Discuss alternatives with an infectious disease specialist

Complicated urinary tract infections

In vitro susceptibility is essential to guide therapy, as high-level drug resistance is more frequently encountered in the patient with complicated UTI (cUTI).
Early consideration of consultation with an infectious diseases specialist is prudent to ensure optimal therapy.

The duration of therapy can be reduced in patients who have prompt resolution of symptoms and who are not severely ill; 7 days of therapy could be considered in patients who respond rapidly, while a longer duration (10-14 days) may be considered in patients who have a delayed response.
A 3-day course of therapy can be considered in women aged 65 years or younger without upper urinary tract symptoms.

The narrowest-spectrum drug that retains appropriate susceptibility is recommended, even if multiple agents, including the initial empiric choice, are found to have susceptibility. In addition, fluoroquinolones, such as ciprofloxacin and levofloxacin, have added risks, including the propensity to select for subsequent infection with more resistant organisms, and thus should be reserved for other uses.

Escherichia coli (trimethoprim/sulfamethoxazole sensitive)

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 7-14 days or

Piperacillin-tazobactam 3.375 g IV q6h for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ertapenem 1 g IV q24h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 5-14 days

Escherichia coli (trimethoprim/sulfamethoxazole resistant)

Piperacillin-tazobactam 3.375 g IV q6h for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ertapenem 1 g IV q24h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days or

Plazomicin 15 mg/kg IV q24hr for up to 7 days (reserve for patients with cUTI who have limited or no alternative treatment options)

Staphylococcus saprophyticus

Amoxicillin-clavulanate 875-125 mg PO BID for 7-14 days or

Ampicillin-sulbactam 3 g IV q6h for 7-14 days or

Cephalexin 500 mg PO QID for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days

Klebsiella species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 7-14 days or

Piperacillin-tazobactam 3.375 g IV q6h for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ertapenem 1 g IV q24h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days or

Plazomicin 15 mg/kg IV q24hr for up to 7 days (reserve for patients with cUTI who have limited or no alternative treatment options)

Proteus species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ertapenem 1 g IV q24h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days or

Plazomicin 15 mg/kg IV q24hr for up to 7 days (reserve for patients with cUTI who have limited or no alternative treatment options)

Enterobacteriaceae species

Trimethoprim/sulfamethoxazole 160 mg/800 mg (1 DS tablet) PO BID for 7-14 days or

Piperacillin-tazobactam 3.375 g IV q6h for 7-14 days or

Cefazolin 2 g IV q8h for 7-14 days or

Ceftriaxone 2 g IV q24h for 7-14 days or

Ertapenem 1 g IV q24h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days or

Plazomicin 15 mg/kg IV q24hr for up to 7 days (reserve for patients with cUTI who have limited or no alternative treatment options)

Pseudomonas aeruginosa

Piperacillin-tazobactam 3.375 g IV q6h for 7-14 days or

Ceftazidime 2 g IV q6-8h for 7-14 days or

Cefepime 2 g IV q8h for 7-14 days or

Imipenem-cilastatin 500 mg IV q6h for 7-14 days or

Meropenem 1 g IV q8h for 7-14 days or

Ciprofloxacin 500-750 mg PO BID or 400 mg IV q12h or extended-release 1 g PO daily for 7-14 days or

Levofloxacin 750 mg PO or IV daily for 7-14 days

Enterococcus faecalis

Amoxicillin 500 mg PO TID for 7-14 days

Discuss alternatives with an infectious disease specialist

RELATED ARTICLES
- Advertisment -

Most Popular