Treatment
10
Table 1. Diagnosis and Treatment for Urinary Tract Infections in
Post-Acute and Long-Term Care Settings
UTI Syndrome and
Associated Clinical and
Microbiological
Findings
a
Recommended
Treatment and
Duration
b
Additional Comments
Asymptomatic Bacteriuria
Diagnostic Test Results:
≥100,000 colony-forming
units (CFUs)/mL of ≥1
species of bacteria
Signs & Symptoms:
Nothing that localizes to
the genito-urinary tract
No antibiotics In general, asymptomatic bacteriuria
does not require treatment. However,
screening for asymptomatic
bacteriuria along with targeted short
course of antibiotic treatment (1 or
2 doses) is recommended prior to a
urologic procedure associated with
mucosal trauma. Antibiotics in these
cases should be initiated 30–60
minutes before the procedure.
Acute Simple Cystitis
Diagnostic Test Results:
≥100,000 CFUs/mL of
≤2 species of bacteria OR
≥100 CFUs/mL of ≥1
species of bacteria in a
specimen collected by
in-and-out catheter
Signs & Symptoms:
Localizing to the bladder
such as acute dysuria,
suprapubic tenderness,
new or worsening
incontinence, frequency,
urgency or gross hematuria
Nitrofurantoin,
5 days
Trimethoprim/
sulfamethoxazole,
3 days
Beta-lactam agents,
3–7 days
Fosfomycin, 1 dose
Fluoroquinolones,
3 days
Male patients and those women
with cystitis who are identified to
be at high risk for treatment failure
(see Table 3) may require treatment
for 7 days. Longer courses (8–14
days) are usually not necessary in
these patients except when there is
a delayed response to treatment or
severe illness (e.g., sepsis, bacteremia).
Nitrofurantoin and fosfomycin
should not be used when the
infection is suspected to extend
beyond the bladder and in severely ill
patients (e.g., sepsis, bacteremia).
Reserve fosfomycin use for treatment
of acute simple cystitis with highly-
resistant Gram-negative pathogens
and for whom hospitalization and/
or intravenous antibiotic therapy
is not warranted. Additional doses
of fosfomycin will be required if
intended treatment duration is >3
days.
Fluoroquinolones (e.g., ciprofloxacin
and levofloxacin) are no longer
considered firstline treatment for
UTIs, and their use should be
minimized. Moxifloxacin should not
be used for UTIs.
