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:

ceftriaxone1,2

+

doxycycline4

N. gonorrhoeae

 

C. trachomatis5

ceftriaxone

+

doxycycline

250 mg IM

 

100 mg PO q12h

1 dose only

 

10 days

> 35 years old:
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

Staphylococcus (coagulase negative) nitrofurantoin (sustained release) 100 mg PO q12h

Enterococcus spp.

amoxicillin

500 mg PO q12h

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

 

see dosing guidelines

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

 

see dosing guidelines

Pseudomonas aeruginosa

piperacillin

+

gentamicin

or

cefepime

3 grams IV q6h

 

see dosing guidelines

 

1 gram IV q12h

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

 

see dosing guidelines

14 days total4

Endomyometritis

clindamycin

+

gentamicin

+ 

ampicillin

Mixed vaginal flora

clindamycin

+

gentamicin

+ 

ampicillin

900 mg IV q8h

 

see dosing guidelines

 

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

 

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