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 T...

Acute...

...oin monohydrate/macrocrystals 100 mg bid...

...for 3 days is an appropriate choice f...

...tes: The threshold of 20% as the r...

...n some countries and regions, trimethoprim 100 mg...

...ta are insufficient to make a recommendation for...

...omethamine 3 g single-dose is an appropri...

...llinam 400 mg bid for 3 to 7 days is an appro...

...e fluoroquinolones ofloxacin, ciprofloxacin, and...

but have a propensity for collateral damage...

...actam agents including amoxicillin-clavulana...

Other β-lactams, such as cephalexin, are less w...

...he β-lactams generally have inferior efficacy an...

...moxicillin or ampicillin should NOT be...


...Acute...

...suspected of pyelonephritis, a urine cultu...

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

...one-time IV agent is utilized, a long-a...

...prevalence of fluoroquinolone resistance is t...

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

...y oral fluoroquinolone, including ciprofloxacin...

TMP-SMX DS bid for 14 days is an appropriate cho...

or a consolidated 24-hour dose of an amino...

...with pyelonephritis requiring hospi...


...ed Urinary Tract Infections...


...able 1. Antibiotics for Acute Uncomplicated Cyst...