mssmem.com

I forget…what did that email say? oh yeah, its at mssmem.com

ABX – Complicated UTI

Men – Cystitis.

Ciprofloxacin 500 mg orally twice daily for 7 days.

OR

Levaquin 500 mg orally once daily for 7 days.

For men <40 years of age it is usually an STD and >40 years of age it is usually E. Coli. Urethritis must be considered in sexually active men less than 40 years of age: examination for penile ulcerations and urine diagnostic tests for Neisseria gonorrhoeae and Chlamydia trachomatis (GC Probe) are warranted in this age group. Avoid Nitrofurantoin and beta-lactams in men with cystitis or pyelonephritis, since they do not achieve reliable prostatic tissue concentrations and would be ineffective for occult prostatitis.

Men – Prostatitis

Ciprofloxacin 500 mg orally twice daily for 4 weeks.

OR

Levaquin 500 mg orally once daily for 4 weeks

Acute prostatitis is manifested with frequency, dysuria, and difficulty urinating with fever and a tender prostate. In the presence of urinary retention or obstruction, and high fever: AVOID digital rectal exam as it could lead to sepsis, in these cases consult Urology.

Men – Acute pyelonephritis

Levaquin 500 mg IV/po once daily 10-14 days

OR

Ciprofloxacin 400 mg IV twice daily for 10-14 days. (can switch to po 500 mg po bid)

All men with pyelonephritis should be evaluated for causative factors.

Pregnant Women – Cystitis

TMP-SMX (160 mg/800 mg) orally twice a day for 7 days (FDA Category C: AVOID in first trimester)

OR

Amoxicillin 500 mg orally twice daily for 7 days. (FDA Category B)

OR

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

OR

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

OR

Cephalexin 250 mg orally four times daily for 7 days. (FDA Category B)

Fluoroquinolones should be avoided in pregnancy. Pregnant women should have a follow-up urine culture performed one to two weeks after treatment to ensure that bacteriuria has been eradicated. Treat as outpatients as long as they do not have symptoms suggestive of pyelonephritis. Have a low threshold for hospitalization.

Pregnant Women – Acute pyelonephritis

Ceftriaxone 1 gram IV every 24 hours for 10-14 days.

In the Mount Sinai 2005 antibiogram for the ED, Ceftriaxone was effective against 97% of E.Coli Isolates.

Nursing Home patients

Ceftriaxone 1 gram IV every 24 hours (preferred)

OR

If multi drug resistant gram negative suspected or previously isolated: Cefepime 1 gram IV every 12 hours.

Risk factors for multi-drug resistant resistant gram negative: frequent hospitalizations (>3) within the past year, recent hospitalization in an acute setting in the past 3 month, spinal cord injury individuals with intermittent catheterization, patients with suprapubic catheters or indwelling urinary catheters. In the Mount Sinai 2005 antibiogram for the ED, Ceftriaxone was effective against 97% of E.Coli Isolates.

——————————————————————————–
The choice of antibiotic should be based on the antimicrobial sensitivity if available. Page the ID pharmacist (9407) or the ID fellow on call for antimicrobial assistance.
——————————————————————————–

Ref: Patterson T. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am 1997 Sep;11(3):593-608.
Nicolle, L. A practical guide to the management of complicated urinary tract infection. Drugs 1997; 53:583.

Written by phil

July 15th, 2006 at 3:37 pm

Posted in Antibiotics