Spectrum: Local Antimicrobial Stewardship, for Prisma Health-Midlands

Acute Cystitis

Uncomplicated or Complicated?

Uncomplicated cystitis

  • Female of childbearing potential

  • No urologic abnormalities

Complicated cystitis

  • >2 UTIs in past 12 months

  • Urologic abnormalities (e.g. stones)

  • Males

  • Indwelling catheters

Avoid

Fluoroquinolones

For example:

  • Ciprofloxacin

  • Levofloxacin

Risk of harmful adverse effects exceeds potential benefits

  • C. difficile infection

  • Tendonitis

  • Neurotoxicity

  • QTc prolongation

  • Induction of antimicrobial resistance

Oral 3rd generation cephalosporins

For example:

  • Cefdinir

  • Cefpodoxime

Low urinary concentrations and high risk of adverse events, including induction of antimicrobial resistance