Template:Acute cystitis antibiotics: Difference between revisions
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===Outpatient=== '''Women, Uncomplicated''' | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Nitrofurantoin|dose=ER 100mg BID x 5d|context=Outpatient, Women Uncomplicated}}, 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 | |||
===Outpatient=== | *{{AntibioticDose|disease=Acute cystitis|drug=Cephalexin|dose=250mg QID x 5d|context=Outpatient, Women Uncomplicated}}, OR | ||
*{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=250mg BID x3d|context=Outpatient, Women Uncomplicated}} | |||
'''Women, Uncomplicated''' | |||
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**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> | **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> | **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''' | '''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, Concern for [[Urethritis|Urethritis]]''' | |||
'''Women, Concern for [[ | *{{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 | ||
* | *{{AntibioticDose|disease=Acute cystitis|drug=Levofloxacin|dose=500mg QD x 14d|context=Urethritis Concern}} (covers urinary pathogens, [[GC|GC]], and [[chlamydia|chlamydia]]) | ||
* | **[[GC|GC]] resistance to fluoroquinolones is increasing | ||
**[[ | |||
'''Men''' | '''Men''' | ||
* | *{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=500mg BID x10-14d|context=Men}}, OR | ||
* | *{{AntibioticDose|disease=Acute cystitis|drug=Cefpodoxime|dose=200 mg BID x10-14d|context=Men}} | ||
===Inpatient Options=== *{{AntibioticDose|disease=Acute cystitis|drug=Ciprofloxacin|dose=400mg IV q12hr|context=Inpatient}}, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Ceftriaxone|dose=1gm IV QD|context=Inpatient}}, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Cefotaxime|dose=1-2gm IV q8hr|context=Inpatient}}, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Gentamicin|dose=3mg/kg/day divided q8hr|context=Inpatient}} +/- ampicillin 1–2 gm q4hr, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Piperacillin/Tazobactam|dose=3.375 gm IV q6hr|context=Inpatient}}, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Cefepime|dose=2gm IV q8hr|context=Inpatient}}, OR | |||
*{{AntibioticDose|disease=Acute cystitis|drug=Imipenem/Cilastatin|dose=500mg IV q8hr|context=Inpatient}} | |||
*{{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 | ||
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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
- Ciprofloxacin 500mg BID x10-14d, OR
- Cefpodoxime 200 mg BID x10-14d
Women, Concern for Urethritis
- Ceftriaxone 250mg IM x1 AND azithromycin 1gm PO x1 AND nitrofurantoin ER 100mg BID x5d, OR
- Levofloxacin 500mg QD x 14d (covers urinary pathogens, GC, and chlamydia)
- GC resistance to fluoroquinolones is increasing
Men
- Ciprofloxacin 500mg BID x10-14d, OR
- Cefpodoxime 200 mg BID x10-14d
===Inpatient Options=== *Ciprofloxacin 400mg IV q12hr, OR
- Ceftriaxone 1gm IV QD, OR
- Cefotaxime 1-2gm IV q8hr, OR
- Gentamicin 3mg/kg/day divided q8hr +/- ampicillin 1–2 gm q4hr, OR
- Piperacillin/Tazobactam 3.375 gm IV q6hr, OR
- Cefepime 2gm IV q8hr, OR
- Imipenem/Cilastatin 500mg IV q8hr
- Cefotetan 500 mg IM/IV q12h
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
- Ceftriaxone 50-75mg/kg IV daily (max 2g)
- Cefotaxime 50mg/kg IV q8hrs (max 2g/dose)
- Gentamicin 2.5mg/kg IV q8hrs +/- Ampicillin 50mg/kg IV q6hrs
- ↑ Choosing Wisely. American Urogynecologic Society. http://www.choosingwisely.org/societies/american-urogynecologic-society
- ↑ 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.