Treatment
8
STEP 7: Choosing Empiric Antibiotics
➤ If prior culture data are available, clinicians should review previously
identified organisms and their susceptibilities before selecting an
antibiotic for treatment.
➤ In the absence of prior culture data, clinicians should refer to facility
or local resistance rates (i.e., antibiograms) to select empiric
antibiotics.
➤ In general, nitrofurantoin and trimethoprim-sulfamethoxazole are
considered preferred drugs for empiric treatment of acute simple
cystitis.
➤ If there is significant concern for multidrug-resistant organisms, oral
fosfomycin trometamol may be effective.
➤ Fluoroquinolones are no longer considered first-line treatment for
UTIs due to the high rate of resistance against these agents as well as
risks for developing serious life-threatening or disabling side effects.
➤ Consider renal function and drug-drug interactions when selecting an
antibiotic for treatment. [See Table 2]
➤ If pyelonephritis is suspected, fosfomycin and nitrofurantoin
should not be used.
➤ If planning to treat a resident in a PALTC facility for suspected
pyelonephritis with an oral antibiotic when susceptibility of the
uropathogen is unknown, an initial dose of long-acting parenteral
agent (such as ceftriaxone) is recommended. The culture results
should be followed and antibiotics tailored once the susceptibility
result of the uropathogen is available.
➤ Oral beta-lactam agents should not be used for treatment of
pyelonephritis when alternative treatment options are available
and, if used, an initial dose of long-acting parenteral agent (such as
ceftriaxone) is recommended.
➤ When there is evidence of systemic infection (warning signs) in
residents with suspected UTI, clinicians should consider empiric
treatment with broad-spectrum agents and then de-escalate based on
the results of the urine studies and the clinical course.
