Spectrum: Local Antimicrobial Stewardship, for Markham Stouffville Hospital

IV Treatment

First Line

Ceftriaxone 1g IV q24h

PLUS*

Ampicillin 1g IV q6h

  • *If prior urine colonization with enterococcus or septic patients with suspected UTI

  • If beta-lactam allergy, use Vancomycin 15-20mg/kg IV Q12H instead of Ampicillin

Second Line

Gentamicin 5mg/kg IV q24h

  • Gentamicin should be avoided in those with impaired renal function.

  • Caution is advised regarding the risk of ototoxicity, especially with prolonged use of gentamicin.

  • If more than 24 hours of treatment with gentamicin is required, then pharmacist involvement is recommended.

PLUS*

Ampicillin 1g IV q6h

  • *If prior urine colonization with enterococcus or septic patients with suspected UTI

  • If beta-lactam allergy, use Vancomycin 15-20mg/kg IV Q12H instead of Ampicillin

Third Line

Ciprofloxacin 400mg IV q12h

  • 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.

  • Choose other agents if possible.

PLUS*

Ampicillin 1g IV q6h

  • *If prior urine colonization with enterococcus or septic patients with suspected UTI

  • If beta-lactam allergy, use Vancomycin 15-20mg/kg IV Q12H instead of Ampicillin

Fourth Line

Consult ID

Treatment Duration

7-14 days depending on resolution.

Patients on ciprofloxacin can be treated with a 5-7 day course.