Answer: It depends on your local antibiogram.
Today, go find out about your hospital's local resistance rates for uropathogens to various antibiotics. For San Francisco General Hospital, I found our 2010 antibiogram publicly posted online. Urine isolates of E. coli demonstrate relatively high resistance rates to trimethoprim-sulfamethoxazole and ciprofloxacin:
- Trimethoprim-sulfamethoxazole resistance rate = 33%
- Cefazolin or Cephalexin resistance rate = 12%
- Ciprofloxacin resistance rate = 16%
- Cystitis: Nitrofurantoin x 5 days, or cephalexin / beta-lactam x 3-7 days
- Pyelonephritis: Ceftriaxone 1 gm IV x 1 + (ciprofloxacin x 7 days or trimethoprim-sulfamethoxazole x 14 days)
Reference
Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG, Moran GJ, Nicolle LE, Raz R, Schaeffer AJ, Soper DE, Infectious Diseases Society of America, & European Society for Microbiology and Infectious Diseases. 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 the European Society for Microbiology and Infectious Diseases. Clinical Infectious Diseases. 2011; 52(5). PMID: 21292654
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Yes! More antibiotics cards please! Each attending has their own preference for things like this so its VERY nice to have something solid to fall back on. I would much prefer to match the antibiotic to the patient than match the antibiotic to the attending, ;)
ReplyDeleteGood point. Will keep a lookout for more of these IDSA guidelines.
ReplyDeleteThanks for the info. I was looking out for some medication against Cystitis. But are these antibiotics relieving?
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