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

...electing a Treatment Regi...

Acute Uncomplicated Cystit...

...in monohydrate/macrocrystals 100 mg bid for 5 da...

...X DS bid for 3 days is an appropria...

...otes: The threshold of 20% as the resistance...

...ntries and regions, trimethoprim 100 mg...

...are insufficient to make a recommendati...

...thamine 3 g single-dose is an appro...

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

...quinolones ofloxacin, ciprofloxacin, and levofl...

...have a propensity for collateral damag...

...tam agents including amoxicillin-clavulanate, cefd...

...lactams, such as cephalexin, are less well s...

...s generally have inferior efficacy and more...

...moxicillin or ampicillin should NO...


...te Pyelonephritis

...nts suspected of pyelonephritis, a urin...

...loxacin 500 mg bid for 7 days with or witho...

...an initial one-time IV agent is util...

...valence of fluoroquinolone resista...

...a consolidated 24-hour dose of an am...

...oral fluoroquinolone, including ciprofloxaci...

...S bid for 14 days is an appropriate choice for...

...consolidated 24-hour dose of an ami...

...with pyelonephritis requiring hospitalization sh...


...omplicated Urinary Tract I...


... Table 1. Antibiotics for Acute Uncompl...