9
STEP 8: De-Escalation of Antibiotics
➤ After selection of an empiric antibiotic, the resident's clinical
response and the results of diagnostic studies should inform whether
continuing antibiotics is warranted.
➤ If the initial antibiotic was a broad-spectrum agent and the culture
results indicate that a more narrow-spectrum agent would be
effective, clinicians should consider changing to the narrow-spectrum
agent.
➤ In cases where organisms recovered from urine cultures are
resistant to the empiric antibiotic selected and residents continue to
experience UTI symptoms, therapy modification is warranted.
➤ If the resident clinically improved despite organisms being resistant
to the empiric antibiotic selected, the organisms recovered from
the urine culture may represent colonization, and discontinuation of
antibiotic therapy should be considered.
➤ When a urine culture collected before initiation of empiric treatment
is negative or the amount of growth reported is below the threshold
for a positive culture, strong consideration should be given to
stopping antibiotics and looking for another etiology of the symptoms.
STEP 9: Determining the Length of Therapy
➤ Length of therapy depends on the type of UTI being treated, antibiotic
agent being used and resident's response to the treatment (such as
prompt recovery within 72 hours versus delayed response).
➤ Table 1 outlines AMDA UTI consensus statement recommended
empiric treatment options and durations for UTI syndromes commonly
managed in PALTC facilities.
➤ Table 2 outlines IOU consensus recommendations for empirical
treatment of acute simple cystitis in nursing home residents. It
includes the dosing consideration for renal function and common
drug-drug interactions to avoid.
➤ Table 3 describes factors that may predispose residents with a UTI
to treatment failure or complications and may impact treatment
duration.
