From the Guidelines
For uncomplicated UTIs caused by E. coli, the best antibiotic options are nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole for 3 days, or fosfomycin as a single dose, as recommended by the American College of Physicians 1. When choosing an antibiotic, it's essential to consider the patient's medical history, allergies, and local resistance patterns.
- Nitrofurantoin is often preferred due to its lower resistance rates and minimal impact on gut flora.
- Trimethoprim-sulfamethoxazole is another effective option, but its use should be guided by local resistance patterns.
- Fosfomycin is a single-dose option that is highly effective against E. coli, making it a convenient choice for patients. For patients with uncomplicated pyelonephritis, fluoroquinolones or trimethoprim-sulfamethoxazole may be prescribed, but the treatment duration is typically longer, at 5-7 days or 14 days, respectively 1. It's crucial to note that fluoroquinolones should not be prescribed empirically due to their high propensity for adverse effects and should be reserved for patients with a history of resistant organisms 1. In all cases, patients should complete the full course of antibiotics, even if symptoms resolve quickly, and drink plenty of fluids to help clear the infection.
- Local resistance patterns and patient-specific factors, such as pregnancy status and renal function, should also be taken into account when selecting an antibiotic.
- Symptoms typically improve within 48 hours of starting treatment, but patients should seek medical attention if symptoms worsen or don't improve after 48-72 hours of treatment.
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 uncomplicated urinary tract infections (mild to moderate) due to Escherichia coli, Klebsiella pneumoniae, or Staphylococcus saprophyticus. Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia
Antibiotic options for UTI with E. coli include Levofloxacin.
- Indications: Complicated and uncomplicated urinary tract infections, acute pyelonephritis
- Organisms covered: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Staphylococcus saprophyticus 2
From the Research
Antibiotic Options for UTI with E. coli
- The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 3.
- High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 3.
- Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 3.
- Treatment oral options for UTIs due to ESBLs-E coli include nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin 3.
Specific Antibiotic Susceptibility
- Fosfomycin, nitrofurantoin, and temocillin showed an excellent susceptibility profile against E. coli isolates from community-acquired urinary tract infections (CA-UTI) in Korea, with susceptibility rates of 100%, 99.4%, and 96.8%, respectively 4.
- Resistance rates of ciprofloxacin and trimethoprim-sulfamethoxazole were 22% and 29.2%, respectively, against E. coli isolates from CA-UTI in Korea 4.
Treatment Guidelines
- The new S3 guideline recommends fosfomycin-trometamol, nitrofurantoin, or pivmecillinam as first-line empirical treatment for uncomplicated cystitis (UC) 5.
- High-dose fluoroquinolones are still recommended as first-line oral treatment for uncomplicated pyelonephritis (UP) 5.
- Asymptomatic bacteriuria should only be treated in exceptional situations such as pregnancy or before urological procedures that will probably injure the mucosa of the urinary tract 5.