What is the preferred antibiotic treatment for urinary tract infections (UTIs)?

From the Guidelines

Ceftriaxone is the recommended empirical choice for patients with urinary tract infections (UTIs) who require intravenous therapy, due to its efficacy and low resistance rates, as stated in the 2024 guidelines by the JAMA network open 1. When considering the treatment of UTIs, several factors come into play, including the severity of the infection, the presence of complicating factors, and the patient's overall health status.

• For uncomplicated cystitis, nitrofurantoin and trimethoprim-sulfamethoxazole are commonly recommended due to their efficacy and low resistance rates 1.
• However, for patients who require intravenous therapy, ceftriaxone is a preferred option due to its broad-spectrum activity and low resistance rates, as noted in the 2024 guidelines by the JAMA network open 1.
• Fluoroquinolones, such as ciprofloxacin, are generally reserved for complicated UTIs or when other options are not suitable, due to concerns about resistance and adverse effects 1.
• The choice of antibiotic should always be guided by local resistance patterns, patient-specific factors, and the severity of the infection, as emphasized in the European Association of Urology guidelines on urological infections 1.
• It is essential to note that the treatment of UTIs should be tailored to the individual patient, taking into account their specific needs and circumstances, and that antibiotic stewardship is crucial to minimize the development of resistance and ensure the effective treatment of infections 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Factors Favoring Ceftriaxone over Quinolones for UTI

• Ceftriaxone is active against many gram-negative bacillary uropathogens, achieving high levels in urine and proximate tissue following single daily doses 2.
• Ceftriaxone has been shown to be successful in treating complicated urinary tract infections, with a success rate of 13 out of 15 cases treated compared to 2 out of 15 cases treated with cefuroxime 3.
• The use of fluoroquinolones, such as ciprofloxacin, for empiric treatment of UTIs should be restricted due to increased rates of resistance 4, 5.
• Ceftriaxone has been compared to ertapenem in the treatment of complicated urinary tract infections, with similar success rates and adverse event profiles 6.
• Ceftriaxone may be a preferred option for UTIs caused by ESBL-producing Enterobacteriaceae, as it has been shown to be effective in treating these infections 4, 5.

Comparison of Ceftriaxone and Quinolones

• Quinolones, such as ciprofloxacin, have high rates of resistance, making them less effective for empiric treatment of UTIs 4, 5.
• Ceftriaxone has a broader spectrum of activity against gram-negative bacillary uropathogens, making it a more effective option for UTIs caused by these organisms 2.
• Ceftriaxone has been shown to be effective in treating complicated urinary tract infections, including those caused by ESBL-producing Enterobacteriaceae 4, 5, 3, 6.

Treatment Options for UTIs

• The recommended first-line empiric antibiotic therapy for acute uncomplicated bacterial cystitis is a 5-day course of nitrofurantoin, a 3-g single dose of fosfomycin tromethamine, or a 5-day course of pivmecillinam 4, 5.
• Second-line options include oral cephalosporins, such as cephalexin or cefixime, fluoroquinolones, and β-lactams, such as amoxicillin-clavulanate 4, 5.
• Ceftriaxone may be a preferred option for UTIs caused by ESBL-producing Enterobacteriaceae, as it has been shown to be effective in treating these infections 4, 5, 3, 6.