Sandbox-GU-Yaz

Asymptomatic bacteriuria

• Treatment of asymptomatic bacteriuria is only recommended for the following patient populations

• Pregnant women
• Patients pending urological procedure
• Women with catheter-acquired bacteruria that persists 48 hours following removal of indwelling catheter (antimicrobial therapy may be considered)
• Renal transplant recipients (antimicrobial therapy may be considered but evidence is insufficient)

• Treatment of asymptomatic bacteriuria is not recommended for the following patient populations

• Premenopausal, nonpregnant women
• Diabetic women
• Older persons residing in the community
• Elderly, institutionalized patients
• Individuals with spinal cord injury
• Catheterized patients while the catheter remains in situ
• Note: Pyuria accompanying asymptomatic bacteriuria is not indicated for antibiotic therapy.

• Asymptomatic bacteriuria

• 1. Causative pathogens

• Escherichia coli
• Klebsiella pneumoniae
• Coagulase-negative staphylococci
• Enterococcus
• Group B streptococci
• Gardnerella vaginalis
• Pseudomonas aeruginosa
• Proteus mirabilis
• Providencia stuartii
• Morganella morganii

• 2. Specific considerations

• 2.1 Women, pregnant

• Preferred regimen (1): Nitrofurantoin 100 mg PO bid for 3–5 days (avoid in glucose-6-phosphate dehydrogenase deficiency)
• Preferred regimen (2): Amoxicillin 500 mg PO tid for 3–5 days
• Preferred regimen (3): Amoxicillin-Clavulanate 500 mg PO bid for 3–5 days
• Preferred regimen (4): Cephalexin 500 mg PO tid for 3–5 days
• Preferred regimen (5): Fosfomycin 3 g PO single dose
• Alternative regimen, second/third trimester only: Trimethoprim PO bid for 3–5 days
• Note (1): Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive.
• Note (2): Monthly screening for recurrent bacteriuria should be undertaken following therapy.
• Note (3): IDSA guidelines recommend 3–7 days of antimicrobial therapy.

• 2.2 Urologic interventions

• Preferred regimen: Trimethoprim-Sulfamethoxazole DS 1 tab PO bid for 3 days after obtaining urine cultures
• Note: Screening for or treatment of asymptomatic bacteriuria prior to transurethral resection of the prostate (TRUS) is recommended