Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

Uncomplicated UTI or Cystitis

Note

Patient characteristics

  • Female (15-45 years old)

  • Generally healthy

  • Absence of fever, flank pain, or other suspicion for pyelonephritis

  • Able to take oral medication

  • Not pregnant

  • No structural or functional abnormalities

Most Common Organisms

E. coli (75-95%)

S. saprophyticus

K. pneumoniae

P. mirabilis

Enterococcus spp.

First Line Treatment

Nitrofurantoin macrocrystals 100mg PO BID x 5 days

  • Nitrofurantoin is likely to be ineffective for those with creatinine clearance less than 30 mL/min – this may apply to elderly patients (greater than 75 years old) with otherwise normal creatinine.

  • Inadequate tissue/blood levels are achieved for treating upper urinary tract infections or bacteremia.

  • Use nitrofurantoin macrocrystals if less than 36 weeks gestation.

  • Do not use nitrofurantoin to treat pyelonephritis because of negligible drug levels in serum and renal parenchyma.

Alternatives (Not in Preferential Order)

Trimethoprim-sulfamethoxazole 1 DS tab PO BID x 3 days

OR

Ciprofloxacin 500mg PO BID x 3 days

  • Ciprofloxacin use is discouraged empirically for most patients due to increasing rates of resistance (may be ineffective) and due to increased risk for Clostridium difficile infection compared to the alternative agents.

  • Ciprofloxacin use during pregnancy remains controversial.

OR

Amoxicillin-Clavulanate 875/125mg PO BID x 5-7 days
  • Beta-lactam agents have higher failure rates then other recommended agents even when cultured organisms are deemed susceptible and require longer duration of treatment.