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Antimicrobials
First line agents preferred, use second or third line agents only if resistance or intolerance. In rare circumstances where cultures are negative but a high suspicion remains, choose from second line agents
If started on parenteral agent, switch to oral agent once patient clinically improving and culture results available
Females: 7 days
Can consider 3 day treatment course in female patient ≤ 65 years old with catheter-associated UTI who have catheter promptly removed
Males: 10-14 days
Amoxicillin 500 mg PO TID
Cephalexin 500 mg PO QID
TMP/SMX 1 DS tab PO BID
Amoxicillin-clavulanate 875-125 mg one tab PO BID
Cefixime 400 mg PO daily
Ciprofloxacin 500 mg PO BID
Renal parenchymal abscess, perinephric abscess, or emphysematous pyelonephritis
Often requires longer duration of therapy. Urology & Infectious Diseases consultation recommended
Renal transplant patients with UTI
May require different durations than those recommended above. Infectious Diseases or Nephrology consultation recommended
How about bacteremia?
Duration of therapy in setting of bacteremic pyelonephritis is no different than cases without bacteremia
Follow-up urine culture
Follow-up urine culture as a test of cure is not recommended unless patient has not responded to therapy or is pregnant
