Prostatitis

UrinaryTract: Non-CatheterAssociatedUrinary Tract Infection/Cystitis CLASSIFICATION CLINICAL FINDINGS RECOMMENDED EMPIRIC REGIMENS CLINICAL CONSIDERATIONS Symptomatic Uncomplicated/ • Pyuria (Urinalysis:≥ 5 Nitrofurantoin (MacroBID)‡ 100 mgPOQ12Hfor5 days • Urineculture should be UrinaryTract: Non-CatheterAssociatedUrinary Tract Infection/Cystitis CLASSIFICATION CLINICAL FINDINGS RECOMMENDED EMPIRIC REGIMENS CLINICAL CONSIDERATIONS Urinary Tract: Non-Catheter Associated Urinary Tract Infection/Cystitis CLASSIFICATION CLINICAL FINDINGS RECOMMENDED EMPIRIC REGIMENS CLINICAL CONSIDERATIONS Symptomatic • Pyuria Nitrofurantoin (MacroBID)‡ • Urine culture Urinary Tract: Non-Catheter Associated Urinary Tract Infection/Cystitis Cystitis Symptomatic Uncomplicated/ • WBC) Pyuria (Urinalysis: ≥ 5 OR Nitrofurantoin (MacroBID)‡ 100 mg PO Q12H for 5 days • performed ONLY IF:Urineculture should be • Female Uncomplicated/ Cystitis AND(Urinalysis:≥ 5 WBC) SMX/TMP1DStablet POQ12Hfor 100 mgPOQ12Hfor5 days OR - Historyofshould be performed ONLY IF: AND Cystitis • Female • Positive WBC) AND urine 3days OR SMX/TMP 1 DS tablet PO Q12H for multipleUTIsperformed ONLY IF:- History of • Nocriteriafor complicated (seeprevious page) • Female AND • Nocriteriafor complicated (seeprevious page) AND • No criteria for complicated (see previous page) culture (≥100,000 cfu/mL)† AND • Presence of symptoms: - Dysuria - Urgency - Frequency - Suprapubic pain AND • Positive urine culture (≥100,000 cfu/mL)† AND • Presence of symptoms: - Dysuria - Urgency - Frequency • Positive urine culture (≥ 100,000 cfu/mL)† AND • Presence of symptoms: - Dysuria - Urgency - Frequency - Suprapubic Alternativeagents should be avoided if possibledueto therisk of C. difficile AND antibiotic resistance. IF patient has an allergy/contraindication tothe above antibioticsalternatives include: Ciprofloxacin250 mg PO Q12H for3 days OR Cephalexin 500 mg PO Q12H for3 days SMX/TMP1DStablet POQ12Hfor 3days Alternativeagents should be avoided if possibledueto therisk of C. difficile AND antibiotic resistance. IF patient has an allergy/contraindication tothe above antibioticsalternatives include: Ciprofloxacin250 mg PO Q12H for3 days OR Cephalexin 500 mg PO Q12H 3 days Alternative agents should be avoided if possible due to the risk of C. difficile AND antibiotic resistance. IF patient has an allergy/contraindication to the above antibiotics alternatives include: Ciprofloxacin 250 mg PO Q12H for 3 days OR Cephalexin 500 mg PO Q12H for 3 days • • • • • • OR MDRO infection(s) Narrow antibiotic therapywhen organismand susceptibilities are known Follow-up urine culturesor UAare onlywarrantedfor - Historyof multipleUTIs OR MDRO infection(s) Narrow antibiotic therapywhen organismand susceptibilities are known Follow-up urine multiple UTIs OR MDRO infection(s) Narrow antibiotic therapy when organism and susceptibilities are known Follow-up urine cultures or UA are - Suprapubic pain for3 days on-going culturesor UAare only warranted for pain symptoms. They onlywarrantedfor on-going should NOT be on-going symptoms. They obtained routinely symptoms. They should NOT be to monitor should NOT be obtained routinely responseto obtained routinely to monitor therapy to monitor response to responseto therapy Urinary Tract:Prostatitis therapy CLASSIFICATION PREFERRED REGIMEN ALTERNATIVE REGIMENS Outpatient Ciprofloxacin500 mgPO Q12H SMX/TMP1DStablet POQ12H OR Urinary Tract: Prostatitis CLASSIFICATION PREFERRED REGIMEN ALTERNATIVE REGIMENS Urinary Tract:Prostatitis CLASSIFICATION PREFERRED REGIMEN ALTERNATIVE REGIMENS Outpatient Ciprofloxacin500 mgPO SMX/TMP1DStablet POQ12H Urinary Tract: Prostatitis CLINICAL CONSIDERATIONS Beta-lactams DO NOT have adequate CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS Beta-lactams DO NOT Outpatient Ciprofloxacin 500 mg PO Q12H Levofloxacin500mg PO once dailySMX/TMP 1 DS tablet PO Q12H OR penetrationintoprostate Beta-lactams DO NOThave adequate Q12H (RequiresIDConsult) OR Levofloxacin500mg PO once daily have adequate penetrationintoprostate Duration ofTreatment:28 daysLevofloxacin 500 mg PO once daily(RequiresIDConsult) penetration into prostate cfu=colony formingunits;DS=doublestrength;H= hour(s);MDRO=multi-drugresistantorganism;PO= by mouth;Q=every; (Requires ID Consult) Duration ofTreatment:28 days SMX/TMP= sulfamethoxazole/trimethoprim;UA= urinalysis;UTI=Urinary TractInfection;WBC=whitebloodcell count Duration of Treatment: 28 dayscfu=colony formingunits;DS=doublestrength;H= hour(s);MDRO=multi-drugresistantorganism;PO= by mouth;Q=every; †Positiveurine culture: cfu= colony forming units; DS= double strength; H= hour(s); MDRO= multi-drug resistant organism; PO= by mouth; Q= every; SMX/TMP= sulfamethoxazole/trimethoprim;UA= urinalysis;UTI=Urinary TractInfection;WBC=whitebloodcell count For Women: 2consecutivevoidedurine specimenswithisolationof>105 cfu/mLofthe samebacterial strainSMX/TMP= sulfamethoxazole/trimethoprim; UA= urinalysis; UTI= Urinary Tract Infection; WBC= white blood cell count †Positiveurine culture: For Men: Asingle,clean-catch,voidedurine specimenwithisolationof>105 cfu/mLfrom1bacterial species†Positive urine culture: For Women: 2consecutivevoidedurine specimenswithisolationof>105 cfu/mLofthe samebacterial strain ‡Nitrofurantoin: ContraindicatedifCrCl< 60mL/min AND only indicatedinacutecystitisFor Women: 2 consecutive voided urine specimens with isolation of >105 cfu/mL of the same bacterial strain For Men: A single, clean-catch, voided urine specimen with isolation of >105 cfu/mL from 1 bacterial species For Men: Asingle,clean-catch,voidedurine specimenwithisolationof>105 cfu/mLfrom1bacterial species ‡Nitrofurantoin: ContraindicatedifCrCl< 60mL/min AND only indicatedinacutecystitis

NOTE:Dosingbased on normalrenal function.Referto Tableof Contentsfor section on AntimicrobialDosingfor Adult

Patients Basedon Renal Function ‡Nitrofurantoin: Contraindicated if CrCl< 60 mL/min AND only indicated in acute cystitis NOTE:Dosingbased on normalrenal function.Referto Tableof Contentsfor section on AntimicrobialDosingfor Adult

NOTE: Dosing based on normal renal function. Refer to Table of Contents for section on Antimicrobial Dosing for Adult Patients Basedon Renal Function Patients Based on Renal Function

References:

1. Hooton TM, Bradley SF, CardenaDD, et al. Diagnosis, prevention, and treatment of catheterReferences: associated urinary tract infection in adults: 2009 international clinical practice guidelines from the Infectious Disease Society of America. CID 2010;50:625-63. 2. Nicolle LE, et al. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005 Mar 1;40(5):643-54. 3. Gupta K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20. References: 1. Hooton TM,BradleySF,CardenaDD,etal.Diagnosis,prevention,and treatmentofcatheter-associatedurinarytractinfectioninadults:2009 international clinical practiceguidelinesfromtheInfectiousDiseaseSociety ofAmerica.CID2010;50:625-63. 2. NicolleLE,etal.InfectiousDiseasesSociety ofAmericaguidelinesforthediagnosisandtreatmentofasymptomaticbacteriuria in adults. Clin Infect Dis. 2005 Mar1;40(5):643-54. 3. GuptaK,etal.Internationalclinicalpracticeguidelinesforthetreatmentofacuteuncomplicated cystitisand pyelonephritis inwomen:A2010 updatebytheInfectiousDiseasesSocietyofAmericaand European SocietyforMicrobiologyand InfectiousDiseases. ClinInfect Dis. 2011 Mar 1. Hooton TM,BradleySF,CardenaDD,etal.Diagnosis,prevention,and treatmentofcatheter-associatedurinarytractinfectioninadults:2009 international clinical practiceguidelinesfromtheInfectiousDiseaseSociety ofAmerica.CID2010;50:625-63. 2. NicolleLE,etal.InfectiousDiseasesSociety ofAmericaguidelinesforthediagnosisandtreatmentofasymptomaticbacteriuria in adults. Clin Infect Dis. 2005 Mar1;40(5):643-54. 3. GuptaK,etal.Internationalclinicalpracticeguidelinesforthetreatmentofacuteuncomplicated cystitisand pyelonephritis inwomen:A2010 updatebytheInfectiousDiseasesSocietyofAmericaand European SocietyforMicrobiologyand InfectiousDiseases. ClinInfect Dis. 2011 Mar 1;52(5):e103-20. PAGE 34 1;52(5):e103-20.