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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Acute Bacterial Uncomplicated Cystitis†}}''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nitrofurantoin]] 100 mg po q12h×5 days'''''<br>OR<br>▸ '''''[[TMP-SMX]]‡ 1 DS tab po q12h×3 days'''''<br>OR<br>'''''▸[[Fosfomycin]] 3 gm single dose'''''<br>OR<br> ▸'''''[[Pivmecillinam]]♦ 400 mg bid×5 days '''''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolones]] for 3 days <br>[[Ofloxacin]] 200–400 mg po bid.<br>[[Ciprofloxacin]] 250 mg bid po or Cipro XR 500 mg q24h<br>[[Levofloxacin]] 250–750 mg po q24'''''<br>OR<br>'''''▸[[β-lactam]] agents for 3-7 days<br>[[Amoxicillin-clavulanate]] 500/125 mg po tid or 875/125 mg po bid <br>[[Cefdinir]] 300 mg po q12h or 600 mg po q24 <br>[[Cefaclor]] 250-500 mg po q8h<br>[[Cefpodoxime-proxetil]] 100-200 mg po q12h'''''<br>'''''Others([[Cephalexin]]250-500 mg po q6h ) not studied well but effective.'''''
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| † Acute uncomplicated cystitis: Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetes female patient.
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| ‡Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months.
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| ♦Pivmecillinam is available in some European countries, not licensed in US.
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Fungal cystitis in the non-neutropenic patient}}''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Candida''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluconazole]] 200 mg PO/IV ×7-14 days'''''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Amphotericin B ]] 0.3 - 0.6 mg/kg IV once daily×1-7 days'''''
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| *Being the most common cause of cystitis(75-90%), E.Coli susceptibility test should be considered to choose the appropriate empirical antimicrobial.Other organisms like Proteus mirabilis, Klebsiella pneumoniae and Staphylococcus saprophyticus are far less common.
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| *[[Nitrofurantoin]], [[fosfomycin]] and mecillinam are prefered as first line treatment because have less resistance among other antibacterials.
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| *[[TMP-SMX]] is preferred to use in areas where the resistance rates are less than 20%
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| *[[Nitrofurantoin]], [[fosfomycin]] and mecillinam shouldn't be used when pyelonephritis is suspected, because they have weak penetration to the renal tissue.
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| *Use of broad-spectrum antimicrobials resulted multi-drug resistant organisms, so they are used as alternative to the first line drugs in case of allergy, availability, or tolerance.
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| ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B| Acute Bacterial Uncomplicated Pyelonephritis}}''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Fluoroquinolones]]'''''<br>'''''[[Ciprofloxacin]] 500 mg PO bid ×7 days<br>[[Levofloxacin]] 750 mg PO q24 × 5 days<br>[[Ofloxacin]] 400 mg Po bid<br>[[Moxifloxacin]] 400 mg PO q24h'''''
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| ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen(14 day regimen)''
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| | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] 160/800 mg PO bid'''''<br>OR<br>'''''▸ Oral[[β-lactam]]<br>[[Amoxicillin-clavulanate]] 875/125 mg po q12h or 500/125 mg po tid or 1000 /125 mg po bid <br>[[Cefdinir]] 300 mg po q12h or 600 mg po q24 <br>[[Cefaclor]] 250-500 mg po q8h<br>[[Cefpodoxime-proxetil]] 100-200 mg po q12h<br>[[Cephalexin]]250-500 mg po q6h not studied well but effective.'''''
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| ==Definition== | | ==Definition== |
Definition
Catheter associated urniary tract infection is defined by the presnce of urinary tract infection symptoms or signs in patients with or indewlling, condom or suprapubic catheters with isolation of one or more bacterial strains≥10³cfu/ml from catheter assembeld urine specimen or midstream voiding specimen in patients who had catheter removed in the last 48 hours. And this is applied after exclusion of other possible sources of infection.
Catheter associated UTI signs and symptoms
General signs and symptoms
The new onset or worsening of any of the following :
- Fever
- Rigors
- Altered mental status
- Malasie or lethargy
After exclusion of alternative diagnosis
Urinary tract specific signs and symptom
- Flank pain
- Costcovertebral angel tenderness
- Acute hematuria
- Pelvic discomfort
After catheter removal
- Urgency
- Frequency
- Dysuria
- Suprapubic pain or tenderness
Patients with spinal cord injury
- Increased spasticity
- Autonomic dysreflexia
- Sence of unease