Antimicrobial Stewardship and Urinary Tract Infections
Abstract
:1. Introduction
2. Definitions
3. Microbiology
4. Antimicrobial Stewardship Opportunities
4.1. Does the Patient Have a UTI? Are Antimicrobials Necessary?
Use antimicrobials only when appropriate
|
Use the appropriate antimicrobial
|
Treat for appropriate duration
|
Consider non-antimicrobial preventive strategies for recurrent uncomplicated cystitis *
|
4.2. Antimicrobial Selection
4.3. Streamlining Empirical Therapy
4.4. Selecting the Correct Dose and Route
4.5. Treatment Duration
4.5.1. Cystitis
Antimicrobial | Dosing and Duration | Efficacy |
---|---|---|
First-Line Agents | ||
Nitrofurantoin monohydrate/macrocrystal b | 100 mg twice daily × 5 days (with meals) |
|
Trimethoprim-sulfamethoxazole c | 160/800 mg twice-daily × 3 days |
|
Fosfomycin trometamol | 3 g sachet in a single dose |
|
Pivmecillinam | 400 mg twice daily × 3–7 days |
|
Second-Line Agents | ||
Fluoroquinolone: Ciprofloxacin c Levofloxacin c | 250 mg twice daily × 3 days 250 mg or 500 mg once daily × 3 days |
|
β-lactamb:(e.g., amoxicillin-clavulanate, cefdinir, cefaclor, and cefpodoxime-proxetil) | 3–7 days |
|
4.5.2. Pyelonephritis
Antimicrobial | Dosing and Duration | Efficacy |
---|---|---|
Fluoroquinolone: |
| |
Trimethoprim-sulfamethoxazole b | 160/800 mg orally twice-daily for 14 days |
|
Oral β-lactam Specific agents are not listed in IDSA guidelines | Duration 10–14 days |
|
4.5.3. Catheter-Associated UTIs
4.6. Prevention Strategies
4.6.1. Recurrent Acute Uncomplicated Cystitis
4.6.2. Catheter-Associated UTIs
4.7. Bacteriuria in Pregnancy
4.8. Long Term Care Facilities
4.9. Surgical Prophylaxis
4.10. Barriers to Guideline Implementation
4.11. Areas of Uncertainty
5. Conclusions and Recommendations
Author Contributions
Conflicts of Interest
References
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Abbo, L.M.; Hooton, T.M. Antimicrobial Stewardship and Urinary Tract Infections. Antibiotics 2014, 3, 174-192. https://doi.org/10.3390/antibiotics3020174
Abbo LM, Hooton TM. Antimicrobial Stewardship and Urinary Tract Infections. Antibiotics. 2014; 3(2):174-192. https://doi.org/10.3390/antibiotics3020174
Chicago/Turabian StyleAbbo, Lilian M., and Thomas M. Hooton. 2014. "Antimicrobial Stewardship and Urinary Tract Infections" Antibiotics 3, no. 2: 174-192. https://doi.org/10.3390/antibiotics3020174
APA StyleAbbo, L. M., & Hooton, T. M. (2014). Antimicrobial Stewardship and Urinary Tract Infections. Antibiotics, 3(2), 174-192. https://doi.org/10.3390/antibiotics3020174