Lactose positive gram negative rods12/30/2023 Gentamicin (Garamycin), 3 mg per kg per day in3 divided doses every 8 hours ‡ §Īmpicillin, 1 g every six hours, and gentamicin, 3 mg per kg per day ‡ Trimethoprim-sulfamethoxazole 160/800 twice dailyĪztreonam (Azactam), 1 g three times daily Sparfloxacin, 400 mg initial dose, then 200 mg per day Trimethoprim-sulfamethoxazole DS, one double-strength tablet twice daily Nitrofurantoin (Macrodantin), 100 mg four times dailyĪmoxicillin-clavulanate potassium (Augmentin), 500 mg twice daily Sparfloxacin (Zagam), 400 mg as initial dose, then 200 mg per day Norfloxacin (Noroxin), 400 mg twice dailyĬiprofloxacin (Cipro), 250 mg twice daily Trimethoprim (Proloprim), 100 mg twice daily Trimethoprim-sulfamethoxazole (Bactrim DS), one double-strength tablet twice daily If gram-positive organism, ampicillin or amoxicillin plus gentamicinįor patients with long-term catheters and symptoms, treat for five to seven daysĪcute uncomplicated urinary tract infections in women Remove catheter if possible, and treat for seven to 10 days If gram-negative organism, a fluoroquinolone If Enterococcus species, ampicillin or amoxicillin with or without gentamicin(Garamycin) Urine culture with a bacterial count of more than 10,000 CFU per mL of urine If Enterococcus species, add oral or IV amoxicillin If parenteral administration is required, ceftriaxone (Rocephin) or a fluoroquinolone Switch from IV to oral administration when the patient is able to take medication by mouth complete a 14-day course If gram-negative organism, oral fluoroquinolone Urine culture with a bacterial count of100,000 CFU per mL of urine Urine culture with a bacterial count of 1,000 to 10,000 CFU per mL of urine Repeat therapy for seven to10 days based on culture results and then use prophylactic therapy If the patient has more than three cystitis episodes per year, treat prophylactically with postcoital, patient-directed * or continuous daily therapy (see text) Symptoms and a urine culture with a bacterial count of more than100 CFU per mL of urine Three-day course is best Quinolones may be used in areas of TMP-SMX resistance or in patients who cannot tolerate TMP-SMX Urinalysis for pyuria and hematuria (culture not required) Asymptomatic bacteriuria rarely requires treatment and is not associated with increased morbidity in elderly patients. Complicated infections are diagnosed by quantitative urine cultures and require a more prolonged course of therapy. The most effective therapy for an uncomplicated infection is a three-day course of trimethoprim-sulfamethoxazole. These infections can be empirically treated without the need for urine cultures. Uncomplicated urinary tract infections are caused by a predictable group of susceptible organisms. Further categorization of the infection by clinical syndrome and by host (i.e., acute cystitis in young women, acute pyelonephritis, catheter-related infection, infection in men, asymptomatic bacteriuria in the elderly) helps the physician determine the appropriate diagnostic and management strategies. Initially, a urinary tract infection should be categorized as complicated or uncomplicated. Recent studies have helped to better define the population groups at risk for these infections, as well as the most cost-effective management strategies. Urinary tract infections remain a significant cause of morbidity in all age groups.
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