Treatment of UTIs
Scenario Empiric Treatment Guidelines (narrow based on UCx)
Asymptomatic bacteruria
Do not treat. Exceptions: pregnant women, renal transplant, prophylaxis prior to invasive urologic procedures (CID 2019;68:1611).
Cystitis (JAMA 2014;16:1677)
Uncomp:
nitrofurantoin (Macrobid 100 mg PO q12h or Macrodantin 100 mg PO q6h) × 5 d or TMP-SMX DS × 3 d or fosfomycin (3 g × 1). Refer to dosing guidelines for ↑ Cr.
Complicated: outPt FQ or TMP-SMX PO × 7–14 d
FQ or TMP-SMX superior to β-lactams (NEJM 2012;366:1028) InPt: CTX or FQ; PO if improving, if growing GPC add vancomycin If catheterized remove or exchange catheter.
Prostatitis
FQ or TMP-SMX PO × 14–28 d (acute) or 6–12 wk (chronic)
Pyelonephritis
OutPt: FQ × 7 d or TMP-SMX PO × 14 d (Lancet 2012;380:452) InPt: CTX × 14 d; if at risk for MDR pathogen cefepime, pip-tazo, carbapenem, or plazomicin (NEJM 2019;380:729) (Δ IV → PO when clinically improved & afebrile 24–48 h, tailor to Cx)
Renal abscess
Drainage + antibiotics as for pyelonephritis