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Paucis Verbis: Antibiotics for Cystitis & Pyelonephritis in Women

Posted Sep 02 2011 12:00am
You diagnose a 35 years old woman with uncomplicated cystitis. She is not diabetic and not pregnant. Which antibiotics should you give? What if she had pyelonephritis?

Answer: It depends on your local antibiogram.

Today, go find out about your hospital's local resistance rates for uropathogens to various antibiotics. For San Francisco General Hospital, I found our 2010 antibiogram publicly posted online. Urine isolates of E. coli demonstrate relatively high resistance rates to trimethoprim-sulfamethoxazole and ciprofloxacin
  • Trimethoprim-sulfamethoxazole resistance rate = 33%
  • Cefazolin or Cephalexin resistance rate = 12%
  • Ciprofloxacin resistance rate = 16%
So based on the new 2010 practice guidelines by the ID Society of America and the European Society for Microbiology and Infectious Diseases, I should give
  • Cystitis: Nitrofurantoin x 5 days, or cephalexin / beta-lactam x 3-7 days
  • Pyelonephritis: Ceftriaxone 1 gm IV x 1 + (ciprofloxacin x 7 days or trimethoprim-sulfamethoxazole x 14 days)


You can download this PV card:  [ MS Word ] [ PDF ]
See  other Paucis Verbis cards .
Reference
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE, Infectious Diseases Society of America, & European Society for Microbiology and Infectious Diseases. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases. 2011; 52(5). PMID: 21292654


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