What is the treatment for Urinary Tract Infection (UTI) using intravenous (IV) antibiotics?

From the Guidelines

Treatment for Urinary Tract Infection (UTI) using Intravenous (IV) Antibiotics

The most effective treatment for a UTI requiring IV therapy is to use a broad-spectrum antibiotic that covers common urinary pathogens, including Gram-negative bacteria such as E. coli, with Ceftriaxone being a recommended option at a dose of 1 gram IV every 24 hours 1.

Suitable Antibiotic Options

• Ceftriaxone: 1 gram IV every 24 hours, especially when the susceptibility of the uropathogen is not known 1.
• Cefepime: 1-2 grams IV every 8-12 hours, particularly in cases where resistance patterns suggest its efficacy.
• Piperacillin-Tazobactam: 3.375-4.5 grams IV every 6-8 hours, which can be considered for infections due to carbapenem-resistant Pseudomonas aeruginosa (CRPA) or difficult-to-treat P. aeruginosa (DTR-PA) 1.

Duration of IV Therapy and Monitoring

The duration of IV therapy typically ranges from 3 to 7 days, depending on the clinical response and the ability to transition to oral antibiotics 1. It is crucial to:

• Monitor the patient's response to therapy and adjust the treatment plan as necessary.
• Obtain urine cultures to guide antibiotic therapy and adjust treatment based on susceptibility results.
• Ensure adequate hydration and address any underlying urinary tract issues, which are important components of managing UTIs.

Guiding Principles for Antibiotic Choice

The choice of antibiotic should be guided by local resistance patterns and the severity of the infection. In cases of multidrug-resistant organisms, such as CRPA or DTR-PA, specific recommendations include the use of Piperacillin-Tazobactam, Ceftazidime, Cefepime, or Colistin, among others, with durations of therapy ranging from 5 to 14 days depending on the clinical syndrome and response to therapy 1.

From the FDA Drug Label

The recommended adult and pediatric dosages and routes of administration are outlined in the following table... Mild to Moderate Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli, K. pneumoniae, or P. mirabilis 0.5 to 1 g IV Every 12 hours 7 to 10 Severe Uncomplicated or Complicated Urinary Tract Infections, including pyelonephritis, due to E. coli or K. pneumoniae 2 g IV Every 12 hours 10

The treatment for Urinary Tract Infection (UTI) using intravenous (IV) Cefepime is:

• Mild to Moderate UTIs: 0.5 to 1 g IV every 12 hours for 7 to 10 days
• Severe UTIs: 2 g IV every 12 hours for 10 days 2

From the Research

Treatment for Urinary Tract Infection (UTI) using Intravenous (IV) Antibiotics

The treatment for UTI using IV antibiotics depends on the type of bacteria causing the infection and its susceptibility to different antibiotics.

• For UTIs due to ESBL-producing Enterobacteriales, parenteral treatment options include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides, and fosfomycin 3.
• For UTIs caused by carbapenem-resistant Enterobacteriales (CRE), treatment options include ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, and aminoglycosides 3.
• For UTIs caused by multidrug-resistant (MDR)-Pseudomonas spp., treatment options include fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides, and colistin 3.
• The use of fluoroquinolones, such as ciprofloxacin, is recommended for serious UTIs when conventional agents have failed or are less desirable 4.
• Administration of a long-acting IV antibiotic for treatment of UTI prior to discharge is recommended when the fluoroquinolone resistance rate exceeds 10% to improve in vitro susceptibility coverage 5.

Factors Affecting Treatment

• Patient demographics and medical history, presumed aetiology, and local resistance patterns should be considered when choosing empirical therapy 4.
• Men and long-term care facility residents are more likely to have resistant uropathogens 5.
• The increased prevalence of MDR Enterobacteriaceae limits available treatment options for infections caused by these organisms 6.

Available Treatment Options

• IV antibiotic options include aminoglycosides, beta-lactam/beta-lactamase inhibitor combinations, imipenem, advanced-generation cephalosporins, and fluoroquinolones 4.
• Older antibiotics, such as fosfomycin, may be used to treat MDR bacteria 6.
• Newer antibiotics, such as ceftazidime/avibactam, meropenem/vaborbactam, and imipenem/relebactam, have been developed to treat resistant Gram-negative bacteria 7.