SandboxAB

Acute Bacterial Uncomplicated Cystitis† Preferred Regimen ▸ Nitrofurantoin 100 mg po q12h×5 days OR ▸ TMP-SMX‡ 1 DS tab po q12h×3 days OR ▸Fosfomycin 3 gm single dose OR ▸Pivmecillinam♦ 400 mg bid×5 days Alternative Regimen ▸ Fluoroquinolones for 3 days Ofloxacin 200–400 mg po bid. Ciprofloxacin 250 mg bid po or Cipro XR 500 mg q24h Levofloxacin 250–750 mg po q24 OR ▸β-lactam agents for 3-7 days Amoxicillin-clavulanate 500/125 mg po tid or 875/125 mg po bid Cefdinir 300 mg po q12h or 600 mg po q24 Cefaclor 250-500 mg po q8h Cefpodoxime-proxetil 100-200 mg po q12h Others(Cephalexin250-500 mg po q6h ) not studied well but effective. † Acute uncomplicated cystitis: Premenopausal, nonpregnant women with no known urological abnormalities or comorbidities,postmenopausal women or well-controlled diabetes female patient. ‡Avoid if resistance prevalence is known to exceed 20% or if used for UTI in previous 3 months. ♦Pivmecillinam is available in some European countries, not licensed in US. Fungal cystitis in the non-neutropenic patient Candida ▸ Fluconazole 200 mg PO/IV ×7-14 days Alternative ▸ Amphotericin B 0.3 - 0.6 mg/kg IV once daily×1-7 days In patients with suspected cystitis, urine culture and susceptibility tests should be performed, with starting of empirical therapy. Being the most common cause of cystitis(75-90%), E.Coli susceptibility test should be considered to choose the appropriate empirical antimicrobial. Nitrofurantoin, fosfomycin and mecillinam are prefered as first line treatment because have less resistance among other antibacterials. TMP-SMX is preferred to use in areas where the resistance rates are less than 20% Nitrofurantoin, fosfomycin and mecillinam shouldn't be used when pyelonephritis is suspected, because they have weak penetration to the renal tissue. 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.