For
acute pyelonephritis, inpatient or outpatient
treatment should continue for 14 days.Women with uncomplicated acute bacterial cystitis, including women 65 years or older, should receive antibiotics for 3 days.For initial treatment of symptomatic lower UTI with pyuria, bacteriuria, or both, urine culture is not required.For treatment of acute uncomplicated cystitis, beta-lactams,
including first-generation cephalosporins and amoxicillin, are less
effective than the preferred antimicrobials listed as treatment
regimens.To diagnose bacteriuria in symptomatic patients, decreasing the
colony count to 1000 to 10,000 bacteria per milliliter will improve
sensitivity without significantly reducing specificity.A proposed performance measure is the percentage of women diagnosed
with acute pyelonephritis who receive antimicrobial treatment for 14
days.For uncomplicated acute bacterial cystitis, recommended treatment regimens are as follows:
Trimethoprim–sulfamethoxazole: 1 tablet (160
mg trimethoprim–800 mg
sulfamethoxazole) twice
daily for 3 days. Adverse
effects may
include fever, rash, photosensitivity, neutropenia, thrombocytopenia, anorexia,
nausea and vomiting, pruritus, headache, urticaria, Stevens-Johnson
syndrome, and toxic epidermal necrosis.Trimethoprim 100 mg twice daily for 3 days. Adverse effects may
include rash, pruritus, photosensitivity, exfoliative dermatitis,
Stevens-Johnson syndrome, toxic epidermal necrosis, and aseptic
meningitis.Ciprofloxacin 250 mg twice daily for 3 days, levofloxacin 250 mg
once daily for 3 days, norfloxacin 400 mg twice daily for 3 days, or
gatifloxacin 200 mg once daily for 3 days. Adverse effects may include
rash, confusion, seizures, restlessness, headache, severe
hypersensitivity, hypoglycemia, hyperglycemia, and Achilles tendon
rupture (in patients older than 60 years).Nitrofurantoin macrocrystals 50 to 100 mg 4 times daily for 7 days,
or nitrofurantoin monohydrate 100 mg twice daily for 7 days. Adverse
effects may include anorexia, nausea, vomiting, hypersensitivity,
peripheral neuropathy, hepatitis, hemolytic anemia, and pulmonary
reactions.Fosfomycin tromethamine 3-g dose (powder) single dose. Adverse
effects may include diarrhea, nausea, vomiting, rash, and
hypersensitivity.For uncomplicated acute bacterial cystitis in women, use of
trimethoprim–sulfamethoxazole for 3 days is the preferred therapy, with
a 94% bacterial eradication rate. In areas where resistance to this
antimicrobial agent is more than 15% to 20%, another of the listed
regimens should be chosen.For women with frequent recurrences of lower UTI, continuous prophylaxis decreases recurrence risk by 95%.Suitable prophylactic regimens for recurrent lower UTI include
once-daily treatment with nitrofurantoin, norfloxacin, ciprofloxacin,
trimethoprim, trimethoprim–sulfamethoxazole, or another antimicrobial
agent listed.The need for continued prophylaxis can be re-evaluated after 6 to 12 months.Acute pyelonephritis traditionally has been treated with
hospitalization and parenteral antibiotics. However, cost-savings
measures have prompted a recent shift to outpatient management,
whenever feasible.
More abstracts about the New Guidelines for management of UTI in non-pregnant women