Template:Acute cystitis antibiotics: Difference between revisions
(Add pediatric outpatient and inpatient UTI dosing)
 
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===Women, uncomplicated===
===Outpatient=== '''Women, Uncomplicated'''
*Nonpregnant, few prior UTI episodes, symptoms <7d, no flank pain or fever
*{{AntibioticDose|disease=Acute cystitis|drug=Nitrofurantoin|dose=ER 100mg BID x 5d|context=Outpatient, Women Uncomplicated}}, OR
#[[Nitrofurantoin]] ER 100mg BID x 5d OR
*{{AntibioticDose|disease=Acute cystitis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=DS (160/800mg) 1 tab BID x 3d (Females) x7days (Males)|context=Outpatient, Women Uncomplicated}}, OR
#[[TMP/SMX]] DS (160/800mg) 1 tab BID x 3d OR
*{{AntibioticDose|disease=Acute cystitis|drug=Cephalexin|dose=250mg QID x 5d|context=Outpatient, Women Uncomplicated}}, OR
#[[Cephalexin]] 250mg QID x 5d OR
*{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=250mg BID x3d|context=Outpatient, Women Uncomplicated}}
#[[Ciprofloxacin]] 250mg BID x3d
**Avoid using fluoroquinolone for the first-line treatment of uncomplicated urinary tract infections (UTIs) in women.<ref>Choosing Wisely. American Urogynecologic Society. http://www.choosingwisely.org/societies/american-urogynecologic-society</ref>
*{{AntibioticDose|disease=Acute cystitis|drug=Fosfomycin|dose=3 g PO once|context=Outpatient, Women Uncomplicated}}
**Lower clinical and microbiologic success compared to nitrofurantoin TID for 5 days <ref>Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., … Harbarth, S. (2018). Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(17), 1781–1789.</ref>
'''Women, Complicated'''
*{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=500mg BID x10-14d|context=Outpatient, Women Complicated}}, OR
*{{AntibioticDose|disease=Acute cystitis|drug=Cefpodoxime|dose=200 mg BID x10-14d|context=Outpatient, Women Complicated}}


===Women, complicated cystitis/pyelo===
'''Women, Concern for [[Urethritis|Urethritis]]'''
*Risks for complicated UTI or symptoms of pyelo
*{{AntibioticDose|disease=Acute cystitis|drug=Ceftriaxone|dose=250mg IM x1|context=Urethritis Concern}} AND [[azithromycin]] 1gm PO x1 AND [[nitrofurantoin]] ER 100mg BID x5d, OR
#[[Ciprofloxacin]] 500mg BID x10-14d OR
*{{AntibioticDose|disease=Acute cystitis|drug=Levofloxacin|dose=500mg QD x 14d|context=Urethritis Concern}} (covers urinary pathogens, [[GC|GC]], and [[chlamydia|chlamydia]])
#[[Cefpodoxime]] 200 mg BID x10-14d
**[[GC|GC]] resistance to fluoroquinolones is increasing


===Women, uncomplicated cystitis AND urethritis===
'''Men'''
#[[Ceftriaxone]] 250mg IM x1 AND azithromycin 1gm PO x1 AND nitrofurantoin ER 100mg BID x5d OR
*{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=500mg BID x10-14d|context=Men}}, OR
#[[Levofloxacin]] 500mg QD x 14d (covers UTI pathogens, GC, and chlam)
*{{AntibioticDose|disease=Acute cystitis|drug=Cefpodoxime|dose=200 mg BID x10-14d|context=Men}}
##GC resistance to fluoroquinolones is increasing


===Men, cystitis/pyelo===
*Consider urethritis and [[prostatitis]]
#[[Ciprofloxacin]] 500mg BID x10-14d OR
#[[Cefpodoxime]] 200 mg BID x10-14d


===Inpatient Options===
===Inpatient Options=== *{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=400mg IV q12hr|context=Inpatient}}, OR
*[[Ciprofloxacin]] 400mg IV q12hr OR
*{{AntibioticDose|disease=Acute cystitis|drug=Ceftriaxone|dose=1gm IV QD|context=Inpatient}}, OR
*[[Ceftriaxone]] 1gm IV QD OR
*{{AntibioticDose|disease=Acute cystitis|drug=Cefotaxime|dose=1-2gm IV q8hr|context=Inpatient}}, OR
*Cefotaxime 1-2gm IV q8hr OR
*{{AntibioticDose|disease=Acute cystitis|drug=Gentamicin|dose=3mg/kg/day divided q8hr|context=Inpatient}} +/- ampicillin 1–2 gm q4hr, OR
*[[Gentamicin]] 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr OR
*{{AntibioticDose|disease=Acute cystitis|drug=Piperacillin/Tazobactam|dose=3.375 gm IV q6hr|context=Inpatient}}, OR
*[[Piperacillin/Tazobactam]] 3.375 gm IV q6hr OR
*{{AntibioticDose|disease=Acute cystitis|drug=Cefepime|dose=2gm IV q8hr|context=Inpatient}}, OR
*[[Cefepime]] 2gm IV q8hr OR
*{{AntibioticDose|disease=Acute cystitis|drug=Imipenem/Cilastatin|dose=500mg IV q8hr|context=Inpatient}}
*[[Imipenem]] 500mg IV q8hr
*{{AntibioticDose|drug=Cefotetan|dose=500 mg IM/IV q12h|context=UTI, uncomplicated|disease=Acute cystitis|population=Adult}}
 
===Pediatric===
*{{AntibioticDose|disease=Acute cystitis|drug=Trimethoprim-Sulfamethoxazole DS|display=TMP/SMX|dose=6-12mg/kg/day (TMP) PO divided BID x 7-10 days|context=Pediatric|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Cephalexin|dose=25-50mg/kg/day PO divided q6-8h x 7-10 days (max 500mg/dose)|context=Pediatric|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Nitrofurantoin|dose=5-7mg/kg/day PO divided q6h x 7-10 days; avoid in infants <1 month|context=Pediatric|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Cefpodoxime|dose=10mg/kg/day PO divided BID (max 200mg/dose)|context=Pediatric|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Cefixime|dose=8mg/kg/day PO daily (max 400mg)|context=Pediatric|population=Pediatric}}
 
====Pediatric Inpatient====
*{{AntibioticDose|disease=Acute cystitis|drug=Ceftriaxone|dose=50-75mg/kg IV daily (max 2g)|context=Pediatric Inpatient|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Cefotaxime|dose=50mg/kg IV q8hrs (max 2g/dose)|context=Pediatric Inpatient|population=Pediatric}}
*{{AntibioticDose|disease=Acute cystitis|drug=Gentamicin|dose=2.5mg/kg IV q8hrs|context=Pediatric Inpatient|population=Pediatric}} +/- [[Ampicillin]] 50mg/kg IV q6hrs

Latest revision as of 12:58, 20 March 2026

===Outpatient=== Women, Uncomplicated

  • Nitrofurantoin ER 100mg BID x 5d, OR
  • TMP/SMX DS (160/800mg) 1 tab BID x 3d (Females) x7days (Males), OR
  • Cephalexin 250mg QID x 5d, OR
  • Ciprofloxacin 250mg BID x3d
    • Avoid using fluoroquinolone for the first-line treatment of uncomplicated urinary tract infections (UTIs) in women.[1]
  • Fosfomycin 3 g PO once
    • Lower clinical and microbiologic success compared to nitrofurantoin TID for 5 days [2]

Women, Complicated

Women, Concern for Urethritis

Men


===Inpatient Options=== *Ciprofloxacin 400mg IV q12hr, OR

Pediatric

  • TMP/SMX 6-12mg/kg/day (TMP) PO divided BID x 7-10 days
  • Cephalexin 25-50mg/kg/day PO divided q6-8h x 7-10 days (max 500mg/dose)
  • Nitrofurantoin 5-7mg/kg/day PO divided q6h x 7-10 days; avoid in infants <1 month
  • Cefpodoxime 10mg/kg/day PO divided BID (max 200mg/dose)
  • Cefixime 8mg/kg/day PO daily (max 400mg)

Pediatric Inpatient

  1. ↑ Choosing Wisely. American Urogynecologic Society. http://www.choosingwisely.org/societies/american-urogynecologic-society
  2. ↑ Huttner, A., Kowalczyk, A., Turjeman, A., Babich, T., Brossier, C., Eliakim-Raz, N., … Harbarth, S. (2018). Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women: A Randomized Clinical Trial. JAMA: The Journal of the American Medical Association, 319(17), 1781–1789.
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