Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

ESBL-Producing Bacteria - Cystitis

First Line Treatment

Contact PHASST

OR

Ertapenem 1g IV Q24h

Duration

Total treatment duration: 7-14 days

IV De-escalation

If IV antibiotics are continued, de-escalate to narrowest spectrum IV antibiotic based on culture and susceptibility results, for example:

Ampicillin

Ampicillin-sulbactam

Cefazolin

Ceftriaxone

Oral De-escalation

Levofloxacin 750mg PO Q24h

  • If CrCl <20-49 mL/min, administer 750mg Q48h

  • If CrCl <20 mL/min, administer 750mg followed by 500mg Q48h

  • Strongly discouraged for treatment of acute cystitis because the risk of harmful adverse effects exceeds potential benefit

OR

Ciprofloxacin 500mg PO Q12h

  • If CrCl <30 mL/min, administer 250mg Q12h

  • Strongly discouraged for treatment of acute cystitis because the risk of harmful adverse effects exceeds potential benefit

OR

SMX/TMP 1 DS PO Q12h

  • Can be used in patients with decreased renal function:

  • If CrCl <30 mL/min, reduce dose to 1 SS PO Q12h

  • Use with caution in pregnant females