Simple Cystitis

• 1^st line
  • Nitrofurantoin (Macrobid) 100mg PO BID x 5 days
    • Avoid use of Macrobid in pts with poor renal fxn (CRCL < 30 mL/min)
  • Cephalexin (Keflex) 1000mg PO TID x 3-5 days
• 2^nd line
  • Fosfomyin 3g PO x 1

Cipro 250mg PO BID x 3 days

Complicated Cystitis

• Male, GU devices, urinary obstruction, diabetic or immunocompromised
• 1^stline
  • Cephalexin (Keflex) 1000mg PO TID x 5-7 days
  • Cefuroxime (Ceftin) 250mg PO BID x 5-7 days
  • Augmentin 875mg PO BID x 5-7 days
• 2^ndline
  • Ciprofloxacin 500mg PO BID x 3-5 days
• 3^rdline
  • Bactrim DS 1 PO BID x 5-7 days

 

 

Pyelonephritis – uncomplicated
Discharge abx

• 1^stline
  • Cephalexin 1000mg PO TID x 7 days
  • Cefuroxime (Ceftin) 500mg PO BID x 7 days
  • Augmentin 875mg PO BID x 7 days
• 2^ndline
  • Cipro 500mg PO BID x 5-7 days
• 3^rdline
  • Bactrim DS 1 PO BID x 7 days

 

Asymptomatic bacteriuria

• Following are NOT indications for treatment of asymptomatic bacteriuria
  • DM / Immunocompromized / Elderly / Foley / Male / SNF
• Asymptomatic bacteriuria in Pregnancy
  • 1^st line: Cephalexin (Keflex) 500mg PO QID x 7 days
  • 2^nd line: Cefuroxime 250mg PO BID x 7 days OR Nitrofurantoin 100mg PO BID x 7 days
    • Cation Nitrofurantoin near term, G6PD deficiency (rare) or renal failure
  • 3^rd line: Bactrim DS 1 PO BID x 3 days (2^nd/3^rd trimesters preferred)
    • Caution use of Bactrim in 1^st trimester