Urinary tract infections

EBM Guidelines

Last updated: 2013-04-04 © Duodecim Medical Publications Ltd

Quick Reference [1]

Urinary tract infection in a child [2]

Essentials

Diagnosis

Treatment

Differential diagnosis

Urethral syndrome

Other diseases to be taken into account

Asymptomatic bacteriuria

Cystitis in female patient

Table 1. Treatment of cystitis in a female patient
DrugDaily doseTreatment duration
Trimethoprim160 mg × 2 or 300 mg × 13 days
Nitrofurantoin75 mg × 23 days
Pivmecillinam200 mg × 3 or 400 mg × 23 days

Acute pyelonephritis

Table 2. Treatment of acute pyelonephritis
  1. When oral treatment is not feasible; after a response is seen, further treatment is carried out with an oral fluoroquinolone, a first generation cephalosporin or sulpha-trimethorprim.
  2. May be used if the strain is known to be sensitive to the drug combination or there are contraindications to fluoroquinolones.
DrugDaily doseTreatment duration
Fluoroquinolone7 days
  • Ciprofloxacin
  1. 500 mg × 2 p.o.
  • Levofloxacin
  1. 250–500 mg × 1 p.o.
  • Ofloxacin
  1. 200 mg × 2 p.o.
Cefuroxime1750–1 500 mg × 3 i.v.10 days
Sulpha-trimethoprim2160/800 mg × 2 p.o.10 days

UTI in a male patient

UTI during pregnancy

Table 3. Treatment of asymptomatic bacteriuria and cystitis during pregnancy
DrugNotes
Nitrofurantoin 75 mg × 2
Pivmecillinam 200 mg × 3Repeated courses of mecillinam should be avoided during pregnancy, because pivmecillinam lowers the serum carnitine concentration.
First generation cephalosporinsCephalexin 500 mg × 3
Amoxicillin 500 mg × 3Can only be used if the sensitivity of the causative agent has been confirmed

UTI among residents in long-term care facilities

Recurrent UTI

Table 4. Alternatives for low-dose prophylactic medication
PrimarySecondary
Trimethoprim 100 mg in the evening Methenamine hippurate 1 g × 2
Nitrofurantoin 50–75 mg in the evening Norfloxacin 200 mg × 1 or at 3 nights per week
Other fluoroquinolone
Table. Alternatives for postcoital antimicrobial prophylaxis
PrimarySecondary
Trimethoprim 100–300 mg in a single doseNorfloxacin 200 mg
Nitrofurantoin 50–75 mg in a single doseOfloxacin 100 mg or ciprofloxacin 100–250 mg
Sulpha-trimethoprim (1 single-strength tablet)

UTI caused by ESBL bacteria

Further investigations

Related resources

References

  1. Auquer F, Cordón F, Gorina E, Caballero JC, Adalid C, Batlle J, Urinary Tract Infection Study Group. Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women. Clin Microbiol Infect 2002 Jan;8(1):50-4.
  2. Sandberg T, Skoog G, Hermansson AB et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet 2012;380(9840):484-90.
  3. Auer S, Wojna A, Hell M. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli. Antimicrob Agents Chemother 2010;54(9):4006-8.
  4. Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum ß-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 2012;67(6):1311-20.