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UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER GUIDELINES FOR ANTIBIOTIC USE
GENITOURINARY TRACT INFECTIONS
| Clinical Setting | Empiric Treatment | Likely Pathogen(s) | Definitive Treatment | Dosing Regimen (normal renal function) |
Duration |
| Gonorrhea | ceftriaxone or cefixime1,2,3 + doxycycline4 |
N. gonorrhoeae
C. trachomatis5 |
ceftriaxone or cefixime + doxycycline |
125 mg IM 400 mg PO
100 mg PO q12h |
1 dose 1 dose
7 days |
| Disseminated Gonococcal Infections | ceftriaxone1,2 +
doxycycline4 |
N. gonorrhoeae
C. trachomatis5 |
ceftriaxone then cefixime2,3,6
doxycycline |
1 gram IV/IM q24h 400 mg PO q12h
100 mg PO q12h |
7 days total therapy
7 days |
| Acute Prostatitis | < 35 years old: |
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ceftriaxone1,2 + doxycycline4 |
N. gonorrhoeae
C. trachomatis5 |
ceftriaxone + doxycycline |
250 mg IM
100 mg PO q12h |
1 dose only
10 days |
|
> 35 years old: |
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| levofloxacin | Enterobacteriaceae | levofloxacin | 500 mg PO q24h | 14 days7 | |
| Chronic Prostatitis | levofloxacin | Enterobacteriaceae Enterococcus spp. |
levofloxacin amoxicillin |
500 mg PO q24h 875 mg PO q12h |
4 weeks7 4 weeks7 |
1 If severe penicillin allergy (urticaria, angioedema, anaphylaxis) or cephalosporin allergy, then call 306-0336 for recommendations.
2 Rates of fluoroquinolone-resistant N. gonorrhoeae in Philadelphia are > 12%. High rates of fluoroquinolone-resistance in N. gonorrhoeae have also been reported in Asia, the Pacific Islands (including Hawaii), California, England and Wales. Therefore, fluoroquinolones are no longer recommended as first line empiric therapy for gonococcal infections in patients from these areas.
3 Cefixime is non-formulary; available as a suspension only (100 mg / 5 mL).
4 If patient is pregnant or compliance is an issue, then use azithromycin 1000 mg PO x 1 dose.
5 Always treat for C. trachomatis due to high co-infection rate.
6 Can switch to oral therapy after 3 days of IV or IM therapy.
7 May require longer duration of therapy.
| Clinical Setting | Empiric Treatment | Likely Pathogen(s) | Definitive Treatment | Dosing Regimen (normal renal function) |
Duration |
| Uncomplicated UTI (admitted < 48 hrs) | cefazolin or cephalexin/cefadroxil1 |
Enterobacteriaceae |
cefazolin |
500 mg IV q8h |
3 days
|
cephalexin/cefadroxil |
500 mg PO q6h / q12h |
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| Staphylococcus (coagulase negative) | nitrofurantoin (sustained release) | 100 mg PO q12h | |||
Enterococcus spp. |
amoxicillin |
500 mg PO q12h |
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| Candida albicans | fluconazole | 100 mg PO q24h | |||
| Uncomplicated UTI (admitted > 48 hrs) | cefazolin2 + gentamicin |
Enterobacteriaceae |
cefazolin | 500 mg IV q8h | 3 days |
cephalexin/cefadroxil |
500 mg PO q6h / q12h |
||||
| Enterococcus spp.3 | ampicillin | 1 gm IV q6h | |||
| amoxicillin | 500 mg PO q12h | ||||
| Pseudomonas aeruginosa | piperacillin + gentamicin |
3 grams IV q6h
|
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| Candida albicans | fluconazole | 100 mg PO q24h | |||
| Complicated UTI (male, catheter, urinary tract abnormalities, flank pain, elevated systemic WBC) | piperacillin + gentamicin
or
cefepime2 |
Enterobacteriaceae | cefazolin | 500 mg IV q8h | 10 days |
| levofloxacin | 250 mg IV/PO q24h | ||||
| Enterococcus spp.3 | ampicillin + gentamicin |
1 gram IV q6h
|
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| Pseudomonas aeruginosa | piperacillin + gentamicin or cefepime |
3 grams IV q6h
1 gram IV q12h |
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| Candida albicans | fluconazole | 100 mg PO q24h | |||
| Pelvic Inflammatory Disease | clindamycin + gentamicin |
N. gonorrhoeae, C. trachomatis, Enterobacteriaceae, Bacteroides spp., Streptococcus spp. | clindamycin + gentamicin |
900 mg IV q8h
|
14 days total4 |
| Endomyometritis | clindamycin + gentamicin + ampicillin |
Mixed vaginal flora | clindamycin + gentamicin + ampicillin |
900 mg IV q8h
2 grams IV q6h |
Variable5 |
1 If severe penicillin allergy (urticaria, angioedema, anaphylaxis) or cephalosporin allergy, then nitrofurantoin (sustained release) 100 mg PO q12h (not for use in patients with creatinine clearances < 60 ml/min).
2 If severe penicillin allergy (urticaria, angioedema, anaphylaxis) or cephalosporin allergy, then levofloxacin 250 mg IV/PO q24h.
3 Review susceptibilities; up to 30% of inpatient isolates may be multi-drug resistant.
4 Continue IV regimen for 48 hours after clinical improvement, then follow with doxycycline 100 mg PO q12h or clindamycin 450 mg PO q6h to complete a total of 14 days of therapy.
5 Continue IV regimen until the patient has a temperature < 37.5 oC for 24 hours, is pain free, and has a normal WBC; use of oral antibiotics after discharge from the hospital is not necessary (unless C. trachomatis is isolated, then treat for 10 days with erythromycin or doxycycline).
Updated on 1/10/06 by Ann Marie Marr, PharmD