standard

² General Treatment Issues

· keep in mind that MIC is extrapolated from data as it pertains to blood, many antibiotics are highly concentrated in the urine and thus sensitivity may change

· to treat a patient that is catheterized, the cath must first be removed

· as GFR is reduced, TMP/SMX, TCN’s, AG’s which get into the urine via filtration have somewhat reduced concentrations

· Pens and Cephs are short lived in the urine dosing once is not generally effective

· Bacteria seed from tissue or organs which can result in recurrent infections or relapse

² Uncomplicated/Community

§ Empiric Therapy Healthy Adult

§ TMP/SMX 1 DS q12h x 3 days

· E. Coli resistance

· Avoid if possible in warfarin patients

· Not effective for Enterococcus, Pseudomonas, Proteus

§ Ciprofloxacin 250-500mg q12h x 3 days

§ Levofloxacin 250-500mg q12h x 3 days

§ Norfloxacin 400mg q12h x 3 days

· Highly concentrated in the urine

· Adjust for renal function

· Some resistance

· Effective for ‘big gram negatives’, Ciprofloxacin has better MIC’s

· Activity vs. Enterococcus fair

§ Ampicillin/Amox 250-500mg q6(8)h x 7 days

· Gram negative resistance by beta-lactamase

· DOC for Enterococcus (resistance by PBP alteration)

· Will not cover ‘big negatives’ or Pseudomonas aeruginosa

§ Augmentin 250mg q8h x 7 days

· Can be used as beta-lactamase resistance is common with gram negatives

· Same general spectrum as Amp/Amox

§ Cephalexin 250-500mg q6h x 7 days

§ Cefixime 200mg q12h x7 days

· First, second, third and gram negative bacteria

· Will not cover Enterococcus, Pseudomonas aeruginosa

§ Nitrofurantoin 50mg q6h or Macrobid 100mg q12h x 7 days

· Will not cover ‘big gram negatives’

· OK for Enterococcus and E. Coli

§ Fosfomycin 3 grams powder in 4 oz water x 1 dose

· Inhibits cell wall

· Works for E. coli and Enterococcus

§ Empiric Therapy Adult >65, Diabetic, HF

· Same therapy as above but not less than 7 days