From the Guidelines
Urinary Tract Infections (UTIs) Resistant to Ceftriaxone and Azithromycin Require Alternative Treatments In cases of UTIs resistant to ceftriaxone and azithromycin, alternative treatment options include fluoroquinolones such as levofloxacin 500mg orally once daily for 7-10 days or ciprofloxacin 500mg orally twice daily for 7-10 days 1. Additionally, consideration may be given to using carbapenems such as meropenem 1g intravenously every 8 hours for 7-10 days or piperacillin-tazobactam 4.5g intravenously every 8 hours for 7-10 days 1.
Key Considerations
- Antimicrobial Resistance: The rise of antimicrobial resistance, particularly in complicated UTIs, poses significant challenges for effective treatment 1.
- Treatment Options: Other potential treatment options include intravenous fosfomycin, plazomicin, and aminoglycosides, although the evidence for these alternatives is not as strong 1.
- Consultation: In severe cases, consultation with an infectious disease specialist is recommended to guide treatment.
Important Treatment Details
- Fluoroquinolones: Levofloxacin and ciprofloxacin are suitable options for outpatient treatment, but their use should be guided by local resistance patterns 1.
- Carbapenems: Meropenem and piperacillin-tazobactam are effective alternatives for severe or complicated UTIs, but their use should be reserved for cases where other options are not suitable 1.
From the Research
Urinary Tract Infection (UTI) Resistant to Ceftriaxone and Azithromycin
- UTIs caused by antibiotic-resistant Gram-negative bacteria are a growing concern due to limited treatment options 2
- High rates of resistance to trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients were recently exposed to them or are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 2
- In the Asia-Pacific region, nearly half of Escherichia coli urinary isolates were resistant to levofloxacin or ciprofloxacin and ≥30% were resistant to third-generation cephalosporins (cefotaxime, ceftriaxone, and ceftazidime) and cefepime 3
- Treatment options for UTIs due to ESBLs-producing Enterobacteriales include nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems 2
- Parenteral treatment options for UTIs due to ESBLs-producing Enterobacteriales include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides, and fosfomycin 2
- Ceftolozane/tazobactam demonstrated significantly higher composite cure rates than levofloxacin in patients with cUTI caused by levofloxacin-resistant bacteria 4
- Nitrofurantoin emerged as the most effective drug for cystitis, while aminoglycosides, piperacillin-tazobactam, and carbapenems demonstrated the highest activity against complicated UTIs 5
- Risk factors for antimicrobial resistances and multidrug resistance (MDR) in UTIs include residence in nursing homes, male gender, hospitalization within the last 30 days, renal transplantation, antibiotic treatment within the last 30 days, indwelling urinary catheter, and recurrent UTI 6
- For patients with no risk factors, Ciprofloxacin, Piperacillin with Tazobactam, Gentamicin, Cefuroxime, Cefpodoxime, and Ceftazidime had high susceptibility rates, but susceptibility decreased with increasing number of risk factors 6