Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women

Publication Date: March 1, 2011

Key Points

Key Points

  • Preferred antibiotics for acute cystitis are nitrofurantoin, or trimethoprim-sulfamethoxazole (TMP-SMX) if local resistance rates are < 20%.
  • In patients suspected of pyelonephritis, a urine culture and susceptibility testing should always be performed.
  • Preferred antibiotics for outpatient pyelonephritis are a fluoroquinolone or TMP-SMX. Consider an initial single-dose IV ceftriaxone or an aminoglycoside if community resistance is > 10% or, for TMP-SMX, if susceptibility unknown.
  • Women with pyelonephritis requiring hospitalization should be initially treated with an IV antimicrobial regimen such as a fluoroquinolone, an aminoglycoside with or without ampicillin, an extended-spectrum cephalosporin or extended-spectrum penicillin with or without an aminoglycoside, or a carbapenem.

Selecting a Treatment Regimen

...Selecting a Treat...

...Acute Un...

...ofurantoin monohydrate/macrocrystals 100 mg bid...

...MP-SMX DS bid for 3 days is an appropriate...

...s: The threshold of 20% as the resistanc...

...ountries and regions, trimethoprim 100 mg bid fo...

...nsufficient to make a recommendation for other c...

...mycin tromethamine 3 g single-dose is...

...400 mg bid for 3 to 7 days is an appropr...

...fluoroquinolones ofloxacin, ciprofloxacin, and le...

...a propensity for collateral damage and s...

...-Lactam agents including amoxicill...

...tams, such as cephalexin, are less we...

...generally have inferior efficacy a...

...cillin or ampicillin should NOT be us...


...Acute Pyelone...

...pected of pyelonephritis, a urine...

...ral ciprofloxacin 500 mg bid for 7 da...

...initial one-time IV agent is utiliz...

...alence of fluoroquinolone resistance is thought to...

...d 24-hour dose of an aminoglycoside is rec...

...al fluoroquinolone, including ciprofloxacin 1000...

...bid for 14 days is an appropriate choic...

...idated 24-hour dose of an aminoglycoside i...

...n with pyelonephritis requiring hospitalization...


...ncomplicated Urinary Tract Infect...


...ntibiotics for Acute Uncomplicated Cyst...