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 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. 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. Acute Bacterial Uncomplicated Pyelonephritis Preferred Regimen ▸ Fluoroquinolones Ciprofloxacin 500 mg PO bid ×7 days Levofloxacin 750 mg PO q24 × 5 days Ofloxacin 400 mg Po bid Moxifloxacin 400 mg PO q24h Alternative Regimen(14 day regimen) ▸ TMP-SMX 160/800 mg PO bid OR ▸ Oralβ-lactam Amoxicillin-clavulanate 875/125 mg po q12h or 500/125 mg po tid or 1000 /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 Cephalexin250-500 mg po q6h not studied well but effective. 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