|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Acute Uncomplicated Cystitis Common organisms: Escherichia coli Staphylococcus saphrophyticus (in sexually active young women) Klebsiella pneumoniae In non-pregnant, premenopausal women with structurally and functionally normal urinary tract |
Nitrofurantoin* 100mg PO q12h** for 7 days OR Cotrimoxazole 960mg q12h for 3-5 days OR Ciprofloxacin 500mg q12h for 3-5 days |
Cefuroxime 250mg PO q12h for 3-5 days |
*Avoid Nitrofurantoin if GFR < 60ml/min. May be used in GFR >30 but <60 with variable outcome. **Based on composition Monohydrate/ macrocrystals composition : 100mg q12h Macrocrystals composition: 50-100mg q6h |
|
Cystitis in Pregnancy |
Nitrofurantoin* 100mg PO q12h for 7 days (Monohydrate/ macrocrystals composition 100mg q12h Macrocrystals composition: 50-100mg q6h) |
Cefuroxime 250mg PO q12h for 5 days OR Amoxicillin-clavulanate# 625mg PO q8h for 5-7 days OR Ampicillin-sulbactam 375-750mg PO q12h for 5-7 days |
Repeat Urine C&S 1-2 weeks after completion of antibiotics to ensure eradication. Treat for 7 days if recurrent. *Avoid Nitrofurantoin in third trimester if another option available due to small risk of haemolytic anemia in newborn. #Amoxicillin-clavulanate is generally safe in pregnancy (Category B), but there may be an increased risk of necrotizing enterocolitis associated with use in preterm, premature rupture of membranes. |
URINARY TRACT INFECTIONS
exp date isn't null, but text field is
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Acute Uncomplicated Pyelonephritis Common organisms: Escherichia coli Staphylococcus saprophyticus (in sexually active young women) Klebsiella pneumoniae Proteus mirabilis |
*Amikacin 1 gm IM/IV q24 for 14 days OR *Gentamicin 7mg/kg/day IM/IV q24h for 14 days |
Piperacillin-tazobactam 4.5 gm IV q6h for 14 days |
Obtain urine culture before starting treatment. Perform ultrasound of the upper urinary tract to exclude obstructive pyelonephritis. May step down to oral antibiotic guided by culture and sensitivity result once can tolerate orally and afebrile ≥48 hours. Monitor renal function closely and rationalize according to culture report. |
|
Infection/Condition and Likely Organism |
Suggested Treatment |
Comments |
|
|
Preferred Treatment |
Alternative Treatment |
||
|
Complicated UTIs Common organisms: Escherichia coli Klebsiella pneumoniae Proteus mirabilis Pseudomonas aeruginosa Enterobacteriaceae Enterococci Pseudomonas spp.
UTI symptoms in men OR presence of a structural or functional abnormality: Urinary tract obstruction Chronic kidney disease Poorly-controlled type 2 diabetes Immunosuppression Urinary catheter in situ Neurogenic bladder Post-menopausal women History of recurrent UTIs Nephrolithiasis |
Ampicillin-sulbactam 1.5-3gm IV q6-8h OR Amoxicillin-clavulanate 1.2gm IV q8h OR Amikacin 1 gm IM/IV q24 for 14 days OR Gentamicin 5mg/kg IM/IV q24 for 14 days OR Piperacillin-tazobactam 4.5 gm IV q6h for 14 days |
Imipenem 1 gm IV q8h OR Meropenem 1 gm IV q8h |
Obtain urine culture before starting treatment and treat for 10-14 days in patients with upper tract symptoms, delayed response or sepsis. May step down to oral antibiotic guided by C&S result once can tolerate orally and afebrile for ≥48 hours. |
|
Asymptomatic Bacteriuria (ABU) Urine bacterial growth ≥ 105cfu/mL of bacteria of same species in 2 serial samples in women obtained 2-7 days apart or a single sample in men without UTI symptoms. |
Nitrofurantoin* 100mg PO q12h for 7 days OR Amoxicillin 500mg PO q12h for 7-10 days Nitrofurantoin Monohydrate/ macrocrystals composition 100mg q12h Macrocrystals composition – 50-100mg q6h |
Cefuroxime 250mg PO q12h for 5-7 days |
*Avoid Nitrofurantoin in third trimester if another option available due to small risk of haemolytic anemia in newborn. Screening for, and treating asymptomatic bacteriuria is not recommended, except in pregnant women, OR prior to transurethral resection of prostate (TURP) or urological procedures breaching the mucosa Whenever indicated, treatment should be guided by urine culture and sensitivity result. |