These guidelines are for empiric treatment. Therapy should be tailored according to urine culture and susceptibility results once available. Once clinically stable, oral therapy is recommended for any patients originally started on IV therapy.
| Indication for Therapy | Usual Causative Organisms | Antibiotic Regimens |
|---|---|---|
| Asymptomatic bacteriuria | Enterobacteriaceae, Enterococcus species, Pseudomonas | No treatment recommended, except in the cases of pregnancy or patients scheduled to undergo invasive urological procedures where mucosal bleeding is expected, such as TURP |
Uncomplicated lower tract (Acute cystitis or urethritis) Uncomplicated UTIs are defined as symptomatic bacteriuria in adult non-pregnant women with apparently normal urinary tracts |
Enterobacteriaceae (including E. coli, Klebsiella, and Proteus), Staphylococcus saprophyticus, Enterococcus species | Nitrofurantoin (MacroBID) 100 mg p.o. every 12 hours for 5 days |
| Co-trimoxazole DS 1 tablet p.o. every 12 hours for 3 days | ||
| Uncomplicated lower urinary tract infection in pregnancy | First-line: amoxicillin/clavulanic acid 875 mg/125 mg p.o. every 12 hours for 5 to 7 days Alternative: cephalexin 500 mg p.o. every 6 hours for 5 to 7 days Alternative: nitrofurantoin (MacroBID) 100 mg p.o. every 12 horus for 7 days* |
|
Complicated or catheter-associated Treat catheter-associated bacteriuria only if clinical symptoms of urinary tract infection are present. |
Enterobacteriaceae (including E. coli, Klebsiella, and Proteus), Staphylococcus saprophyticus, Enterococcus species | Co-trimoxazole DS 1 tab p.o. every 12 hours for 7 days |
| Amoxicillin/clavulanic acid 875 mg /125 mg p.o. every 12 hours for 7 days | ||
| Pseudomonas | CefTAZidime 1 g IV every 8 hours for 7 days | |
| Ciprofloxacin 500 mg p.o. every 12 hours for 7 days** | ||
Upper tract Mild-to-moderate pyelonephritis not requiring hospitalization in women |
Enterobacteriaceae (including Serratia, Enterobacter, and Citrobacter), S. saprophyticus, and Enterococcus species | Co-trimoxazole DS 1 tab p.o. every 12 hours for 7 days |
| Ciprofloxacin 500 mg p.o. every 12 hours for 7 days | ||
Upper tract Moderate-to-severe acute pyelonephritis |
Enterobacteriaceae (including Serratia, Enterobacter, and Citrobacter), S. saprophyticus, and Enterococcus species | CefTRIAXone 1 g IV every 24 hours for 7 days |
| Ciprofloxacin 500 mg p.o. every 12 horus for 7 days | ||
| In pregnancy: ceftriaxone 1 g IV every 24 hours for 7 days |
* There is a theoretical risk of hemolytic anemia in the fetus or newborn, especially in those with G6PD deficiency, but case reports are rare. Numerous studies have shown the use of nitrofurantoin in pregnancy to be safe1,3.
** Therapy can be stopped at 3 days in individuals less than 60 years if catheter is removed.
Nicolle LE, Bradley S, Colgan R, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis 2005;40:643-54.
Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-Course Nitrofurantoin for the Treatment of Acute Uncomplicated Cystitis in Women. Arch Intern Med. 2007;167(20):2207-2212.
Lee M, Bozzo P, Einarson A, et al. Motherisk Update Urinary tract infections in pregnancy. Can Fam Physician 2008;54:853-4.
Wagenlehmner FME, Weidner W, Naber KG. An update on uncomplicated urinary tract infections in women. Curr Opin Urol 2009;19:368-74.Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis 2011;52:e103-20.