Among the tested antimicrobials, E. Of the more than 38, isolates, 7. The Pacific and Mountain regions had a Fluoroquinolones have become popular treatments for patients with uncomplicated UTI because of E. The reported resistance rate of E. A study 18 comparing multidose regimens of ciprofloxacin showed that the minimal effective dosage was mg twice daily.
Another study 19 compared a single mg dose of gatifloxacin Tequin , with three-day regimens of gatif loxacin mg twice daily and ciprof loxacin mg twice daily. The single-dose therapy had a clinical response rate equivalent to the two three-day regimens. Gatifloxacin is also expected to be 1, times less likely than older fluoroquinolones to become resistant because of its 8-methoxy structure. Fosfomycin Monurol is another treatment option for patients with UTI. The U. A study 20 comparing a single dose of fosfomycin 3 g with a seven-day course of nitrofurantoin mg twice daily showed similar bacteriologic cure rates 60 versus 59 percent, respectively.
Increasing resistance, however, has limited their effectiveness. Cephalosporins are pregnancy category B drugs, and a seven-day regimen can be considered as a second-line therapy for pregnant women. Ciprofloxacin Cipro. Gatifloxacin Tequin. Physicians commonly recommend nonpharmacologic options e. A Cochrane review 22 found insufficient evidence to recommend the use of cranberry juice to manage UTI.
Similarly, no scientific evidence suggests that women with cystitis should increase their fluid intake, and some doctors speculate that increased fluid may be detrimental because it may decrease the urinary concentration of antimicrobial agents. Treating older women who have UTIs requires special consideration.
The study, which included outpatient and institutionalized women with an average age of approximately 80 years, showed a 96 percent bacteriologic eradication rate with ciprofloxacin compared with an 80 percent eradication rate with TMP-SMX for the three most common isolates. The three-day therapy had a higher failure rate when compared with the seven-day regimen.
The incidence of UTI in men ages 15 to 50 years is very low, and little evidence exists on treating them. Risk factors include homosexuality, intercourse with an infected woman, and lack of circumcision.
The limited available data are similar on two key points. First, the data show that men should receive the same treatment as women with the exception of nitrofurantoin, which has poor tissue penetration. After reviewing the available clinical data as of and classifying it by quality of evidence, the IDSA published guidelines for the use of antimicrobial agents to treat women with UTI. Second, although it recognizes that they have efficacy rates similar to TMP-SMX, the IDSA does not recommend fluoroquinolones as universal first-line agents because of resistance concerns.
Third, the IDSA recommends a seven-day course of nitrofurantoin or a single dose of fosfomycin as reasonable treatment alternatives. Finally, the IDSA does not recommend the use of betalactams because multiple studies have shown them to be inferior when compared with other treatments.
Figure 1 is an algorithm for the management of uncomplicated UTIs. Algorithm for the management of uncomplicated urinary tract infections. Already a member or subscriber? Log in. Interested in AAFP membership? Learn more.
She received her medical degree at the University of Oklahoma College of Medicine-Tulsa, where she also completed a family medicine residency. Address correspondence to Susan A. Mehnert-Kay, M. Louis Ave. Reprints are not available from the author. The author thanks Karen Malnar, R. National Institutes of Health. Nicolle LE. Urinary tract infection: traditional pharmacologic therapies.
Dis Mon. Faro S, Fenner DE. Urinary tract infections. Clin Obstet Gynecol. Perfetto EM, Gondek K. Escherichia coli resistance in uncomplicated urinary tract infection: a model for determining when to change first-line empirical antibiotic choice. Manag Care Interface. Diagnosis and treatment of uncomplicated urinary tract infection. Infect Dis Clin North Am. Vosti KL. Infections of the urinary tract in women: a prospective, longitudinal study of women observed for 1—19 years.
Medicine Baltimore. HMO Pract. Orenstein R, Wong ES. Urinary tract infections in adults. Am Fam Physician. The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women. Am J Med. A randomized controlled trial of telephone management of suspected urinary tract infections in women. J Fam Pract. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection.
J Antimicrob Chemother. Comparison of once-daily extended-release ciprofloxacin and conventional twice-daily ciprofloxacin for the treatment of uncomplicated urinary tract infection in women. Clin Ther. Susceptibility of antimicrobial-resistant urinary Escherichia coli isolates to fluoroquinolones and nitrofurantoin.
Clin Infect Dis. Multidrug-resistant urinary tract isolates of Escherichia coli : prevalence and patient demographics in the United States in Antimicrob Agents Chemother.
Porphyria or thyroid dysfunction. Disorders of potassium metabolism. Monitor for electrolyte abnormalities, hematologic toxicity. Maintain adequate hydration. Discontinue at 1 st sign of skin rash or any other serious reaction. Embryo-fetal toxicity. Nursing mothers. See Contraindications. May potentiate oral anticoagulants eg, warfarin , hypoglycemics, phenytoin, methotrexate, digoxin; monitor. May be potentiated by indomethacin. May increase risk of thrombocytopenia with diuretics esp.
Nephrotoxicity with cyclosporine in renal transplant. May antagonize tricyclic antidepressants. May interfere with assays for serum methotrexate, creatinine. PJP treatment: avoid leucovorin. Nausea, vomiting, anorexia, allergic skin reactions, blood dyscrasias eg, megaloblastic anemia , hemolysis, hepatic or renal toxicity, crystalluria, pancreatitis, photosensitivity, drug fever, rash may be serious, eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms, others , hypoglycemia, hyperkalemia, hyponatremia; C.
Drugs » Infectious Diseases Bacterial infections Bacterial infections: Indications for: BACTRIM Susceptible infections including UTIs not for initial uncomplicated episodes , shigellosis, prophylaxis and treatment of Pneumocystis jiroveci pneumonia PJP , travelers' diarrhea or acute exacerbations of chronic bronchitis in adults, acute otitis media in children.
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