From the Guidelines
Uncomplicated Urinary Tract Infections (UTIs) should be treated with first-line antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin.
- For women with uncomplicated bacterial cystitis, clinicians should prescribe short-course antibiotics with either nitrofurantoin for 5 days 1, trimethoprim–sulfamethoxazole (TMP–SMZ) for 3 days 1, 2, or fosfomycin as a single dose 1, 2.
- In men and women with uncomplicated pyelonephritis, clinicians should prescribe short-course therapy either with fluoroquinolones (5 to 7 days) 1, 3 or TMP–SMZ (14 days) 1, 3 based on antibiotic susceptibility.
- The choice of antibiotic and duration of treatment should be guided by local resistance patterns, patient comorbidities, and clinical presentation 1, 2, 3.
- Fluoroquinolones are highly efficacious in 3-day regimens but have a high propensity for adverse effects and thus should not be prescribed empirically and should instead be reserved for patients with a history of resistant organisms 1, 2.
- β-lactam agents are not recommended for pyelonephritis due to insufficient data 1, 3.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa Levofloxacin tablets are indicated for the treatment of uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus.
The recommended antibiotic for Urinary Tract Infection (UTI) is levofloxacin, which can be used to treat:
- Complicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, Enterobacter cloacae, or Pseudomonas aeruginosa
- Uncomplicated UTIs caused by Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus 4
From the Research
Recommended Antibiotics for Urinary Tract Infection (UTI)
- First-line antibiotics for uncomplicated UTIs in women include: + Nitrofurantoin for five days 5 + Fosfomycin in a single dose 5, 6 + Trimethoprim for three days 5 + Trimethoprim/sulfamethoxazole for three days 5
- First-line antibiotics for uncomplicated UTIs in men include: + Trimethoprim 5 + Trimethoprim/sulfamethoxazole 5 + Nitrofurantoin for seven days 5
- For UTIs caused by antibiotic-resistant Gram-negative bacteria, recommended treatment options include: + Nitrofurantoin 6 + Fosfomycin 6 + Pivmecillinam 6 + Fluoroquinolones 6, 7, 8, 9 + Oral cephalosporins such as cephalexin or cefixime 6 + β-lactams, such as amoxicillin-clavulanate 6
- For UTIs caused by ESBL-producing Enterobacteriales, treatment options include: + Nitrofurantoin 6 + Fosfomycin 6 + Pivmecillinam 6 + Amoxicillin-clavulanate 6 + Finafloxacin 6 + Sitafloxacin 6
- For UTIs caused by carbapenem-resistant Enterobacteriales (CRE), treatment options include: + Ceftazidime-avibactam 6 + Meropenem/vaborbactam 6 + Imipenem/cilastatin-relebactam 6 + Colistin 6 + Fosfomycin 6 + Aztreonam 6 + Aminoglycosides including plazomicin 6 + Cefiderocol 6 + Tigecycline 6
Considerations for Antibiotic Selection
- Local susceptibility patterns and resistance rates should be considered when selecting an antibiotic 5, 6
- Patient factors, such as allergy history and previous antibiotic use, should be taken into account when choosing an antibiotic 5
- The risk of complications and the potential for antibiotic resistance should be considered when selecting an antibiotic 5, 6