Spectrum: Local Antimicrobial Stewardship, for Eastern Health

Female Uncomp Pyelo Rx

Note

There is a high prevalence of asymptomatic bacteriuria and pyuria in nursing home patients, which does NOT require treatment.

UTI should only be diagnosed and treated in patients with genitourinary symptoms.

Avoid catheterization

For patients with nonspecific symptoms (falls, change in mental status) without signs of sepsis, improving hydration often resolves symptoms - suggest withholding ABx 24hrs and reassess

Contributing factors to UTI should be assessed and managed where possible: i.e., cystocele, incomplete bladder emptying, vaginal trophy

Directed Rx

Step down to oral once tolerating PO intake and improving

Beta-lactams including cephalexin, cefuroxime, cefixime, amoxicillin, and amoxicillin-clavulanate may be used if susceptible but require 14d of therapy

TMP-SMX is preferred when susceptible for a duration of 7-10 days

Fluoroquinolones may be used for a duration of 7 days

Fosfomycin and nitrofurantoin can NOT be used for pyelonephritis due to inadequate tissue penetration

Ertapenem should generally be used for ESBL pyelonephritis