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ABX – Uncomplicated UTI in Women

Cystitis – with the following:

  • Has no history of allergy to Sulfa drug
  • Has not been on antibiotics, especially TMP-SMX, in the past three months for any reason.
  • Has not been hospitalized recently

TMP-SMX (160 mg/800 mg) orally twice a day for 3 days

E. coli is the causative pathogen in approximately 80 to 85 percent of episodes of acute uncomplicated cystitis. Staphylococcus saprophyticus is responsible for most other episodes. E. Coli resistance to TMP-SMX is about 10 % in the northeast US.
There is no apparent benefit in extending therapy with TMP-SMX or a fluoroquinolone past three days, and adverse reactions are more common in patients treated with longer regimens. This also appears to apply to women over the age of 65 years
Allergy to TMP-SMX

Cystitis with Risk factors for TMP-SMX resistance including:

  • Moderate to severe symptoms
  • Women who might find it difficult to seek additional care if their symptoms do not significantly improve over a short time: homelessness or lack of health insurance.

Ciprofloxacin 250 mg orally twice a day for 3 days

OR

Nitrofurantoin (Macrodantin) 100 mg four times a day for 7days

OR

Macrobid (the extended release-XR-form of nitrofurantoin) 100 mg twice a day for 7 days can be prescribed for outpatient use only.

The antimicrobials currently recommended for cystitis, TMP-SMX, nitrofurantoin, and fluoroquinolones, have excellent activity in vitro against S. saprophyticus.
The prevalence of resistance to nitrofurantoin among E. coli is less than 5 percent.
For patients with allergies to both TMP-SMX and/or Fluroquinolones, another option is Keflex 250 mg po four times a day for 7 days, although compliance with such a regimen might be an issue.

Pyelonephritis

Fever (>38ÂșC), flank pain, costovertebral angle tenderness, and nausea or vomiting suggest upper tract infection and warrant more aggressive diagnostic and therapeutic measures.

If outpatient therapy for mild pyelonephritis is a possibility in a patient tolerating oral medications/diet, would treat for 10 days with a fluroquinolone.

Ceftriaxone 1 g IV once a day

OR

Ciprofloxacin 500 mg po twice a day (or 400 mg IV twice a day if unable to take oral)
OR

Levaquin 500 mg orally once a day (or IV if unable to take po)

In the Mount Sinai 2005 antibiogram for the ED, Ceftriaxone was effective against 97% of E.Coli Isolates. E. Coli resistance to the fluoroquinolones remains well below 5 percent in most studies.

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Note: Patients with urethritis and vaginitis also may complain of dysuria, thereby presenting a diagnostic challenge. Urethritis caused by Neisseria gonorrheae or Chlamydia trachomatis is relatively more likely to be present if in the
setting of a sexually transmitted disease (STD).

Written by phil

July 15th, 2006 at 3:35 pm

Posted in Antibiotics