Paucis Verbis: Antibiotics for Cystitis & Pyelonephritis in Women

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)