Selecting a Treatment Regimen Uncomplicated Urinary Tract Infections
Acute Uncomplicated Cystitis
Acute Pyelonephritis
Nitrofurantoin monohydrate/ macrocrystals 100 mg bid x 5 d
OR
TMP-SMX DS bid x 3 d OR
Fosfomycin 3 g once OR
If preferred agents cannot be used
amoxicillin-clavulanate, cefdinir, cefaclor, or
cefpodoxime-proxetil x 3-7 d or
fluoroquinolone x 3 d
Oral ciprofloxacin 500 mg bid x 7 d
OR † Ciprofloxacin ER
1000 mg daily x 7 d OR levofloxacin 750 mg daily x 5 d
OR †
Oral TMP-SMX DS 160/800 mg bid x 14 d
OR
Oral β-lactam (less effective) plus initial IV ceftriaxone 1 g
OR IV 24-hour dose of aminoglycoside
Women NOT requiring hospitalization
Women requiring hospitalization
Urine C&S
*†
IV fluoroquinolone OR
an aminoglycoside with or without ampicillin OR
an extended-spectrum cephalosporin or an extended-spectrum penicillin with or without an
aminoglycoside OR
a carbapenem
*
* Choice depends on local resistance patterns and patient factors (history of resistant organisms or drug allergies). If susceptibility of the infecting pathogen is not known, start with broader-spectrum regimens and tailor down based on culture results.
† WITH OR WITHOUT initial IV ciprofloxacin 400 mg OR initial IV ceſtriaxone 1 g OR initial IV 24-hour dose of aminoglycoside
NOTE: The green boxes are preferred regimens.
