Urology

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Common organisms:

Enterobacteriaceae

Enterococci

Pseudomonas spp.

Staphylococcus aureus

Amoxicillin-clavulanate 1.2gm IV q8h

OR

Ampicillin-sulbactam 3gm IV q6-8h

PLUS

Gentamicin 5mg/kg IV q24h

Ceftriaxone 2gm IV q24h

OR

Cefuroxime 750mg IV q8h

PLUS

Gentamicin 5mg/kg IV q24h

Blood and urine cultures before starting treatment. Pus for C&S.

Drainage ± definitive surgical therapy.

Oral antibiotic once afebrile and feeding orally > 48 hours following catheter removal.

Duration: 2-3 weeks  (Longer if difficult to drain abscess or slow resolution).

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Acute Prostatitis

Common organisms:

Enterobacteriaceae

Enterococci

Pseudomonas spp.

Outpatient treatment: Trimethoprim-sulfamethoxazole 160/800mg PO q12h

OR

Ciprofloxacin 500mg PO q12h

Obtain urine culture before starting treatment.

Duration: 2 -4 weeks.

Inpatient treatment:

Amoxicillin-clavulanate 1.2gm IV q8h

OR

Ampicillin-sulbactam 3gm IV q6-8h

PLUS*

Gentamicin 5mg/kg IV q24h

Ceftriaxone 1-2gm IV q24h

OR

Cefuroxime 750mg IV q8h

PLUS*

Gentamicin 5mg/kg IV q24h

Chronic Bacterial Prostatitis

(NIH Type II)

Chronic or recurrent urogenital symptoms that persist for at least 3 months.

Relapsing UTI with repeated isolation of same organism from urine is the hallmark

Trimethoprim-sulfamethoxazole  160/800mg PO q12h

Ciprofloxacin 500mg PO q12h

Reassess after 2 weeks of antimicrobial therapy.

Only continue antibiotics if pre-treatment cultures are positive and/or symptoms improve.

Duration: 4-6 weeks.

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Epididymo-orchitis (non-STD related)

Common organisms:

Enterobacteriaceae

Enterococci

Pseudomonas spp.

Acute onset, usually unilateral scrotal pain swelling with or without fever, rigors, and lower urinary tract symptoms

Ciprofloxacin 500mg PO q12h for minimum of 2 weeks

For STD related epididymo-orchitis, refer to national STD guidelines.

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred Treatment

Alternative Treatment

Common organisms:

Enterobacteriaceae

Enterococci

Pseudomonas spp.

Amoxicillin-clavulanate 1.2gm IV q8h

OR

Ampicillin-sulbactam 3gm IV q6-8h

OR

Cefuroxime 750mg IV q8h

PLUS*

Gentamicin 5mg/kg IV q24h

Ceftriaxone 2gm IV q24h

PLUS*

Gentamicin 5mg/kg IV q24h

Drainage is the mainstay of treatment.

Send pus for culture and sensitivity.