What is the appropriate treatment for a patient with a urinary tract infection (UTI) caused by Escherichia coli (E. coli) with a colony-forming unit (CFU) count of greater than 100,000 CFU/mL?

From the Guidelines

The most appropriate treatment for a patient with a urinary tract infection (UTI) caused by Escherichia coli (E. coli) with a colony-forming unit (CFU) count of greater than 100,000 CFU/mL is nitrofurantoin, given its good in vitro activity against E. coli in all regions, as reported in a 2010 update by the Infectious Diseases Society of America and the European Society for Micrology and Infectious Diseases 1.

Treatment Options

• Nitrofurantoin is a suitable choice, with a recommended dose of 100 mg orally twice daily for 5-7 days.
• Other alternatives, such as fosfomycin, could be considered based on local resistance patterns and patient-specific factors.
• The choice of antibiotic should be guided by local resistance patterns, as resistance rates vary considerably between regions and countries 1.
• Patient-specific factors, such as allergies, pregnancy status, and renal function, should also be taken into account when selecting an antibiotic.

Rationale

• The provided urine culture results show that the E. coli strain is susceptible to nitrofurantoin, with an MIC of <=16.
• Nitrofurantoin has been shown to have good in vitro activity against E. coli in all regions, making it a reliable choice for empirical therapy 1.
• Local resistance patterns and patient-specific factors should be considered when selecting an antibiotic to ensure effective treatment and minimize the risk of resistance development.

Additional Considerations

• Patients should complete the full course of antibiotics, even if symptoms improve quickly, to ensure complete elimination of the infection.
• Drinking plenty of water can help flush bacteria from the system, and pain relievers like acetaminophen or ibuprofen can be used for discomfort if needed.
• A follow-up urine culture may be necessary in certain cases to confirm resolution of the infection.

From the FDA Drug Label

1.3 Uncomplicated and Complicated Urinary Tract Infections (including pyelonephritis) Cefepime Injection is indicated for uncomplicated and complicated urinary tract infections (including pyelonephritis) caused by Escherichia coli or Klebsiella pneumoniae, when the infection is severe, or caused by Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis, when the infection is mild to moderate, including cases associated with concurrent bacteremia with these microorganisms.

The appropriate treatment for a patient with a urinary tract infection (UTI) caused by Escherichia coli (E. coli) with a colony-forming unit (CFU) count of greater than 100,000 CFU/mL is Cefepime Injection. The recommended dosage is:

• For mild to moderate uncomplicated or complicated UTIs: 0.5-1 g IV every 12 hours for 7-10 days
• For severe uncomplicated or complicated UTIs: 2 g IV every 12 hours for 10 days 2

From the Research

Treatment Options for Urinary Tract Infection (UTI) Caused by Escherichia coli (E. coli)

The patient has a urinary tract infection (UTI) caused by Escherichia coli (E. coli) with a colony-forming unit (CFU) count of greater than 100,000 CFU/mL. The antimicrobial susceptibility test results show that the E. coli isolate is susceptible to several antibiotics, including amoxicillin-clavulanate, amp/sulbactam, cefepime, ceftazidime, ceftriaxone, gentamicin, imipenem, meropenem, nitrofurantoin, and piperacillin-tazobactam.

Recommended Treatment Options

Based on the study by 3, 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.

• Nitrofurantoin is a suitable option for the treatment of UTI caused by E. coli, as it is effective against this pathogen and has a low resistance rate 4, 5, 6.
• Other treatment options include amoxicillin-clavulanate, cefepime, ceftazidime, ceftriaxone, gentamicin, imipenem, meropenem, and piperacillin-tazobactam.

Considerations for Treatment

When selecting a treatment option, it is essential to consider the local susceptibility patterns of E. coli and the patient's medical history, including any allergies or previous antibiotic use 7. Additionally, the treatment should be guided by the results of the antimicrobial susceptibility test to ensure that the selected antibiotic is effective against the E. coli isolate.

Resistance Patterns

The study by 7 highlights the importance of considering resistance patterns when selecting a treatment option. The results show that E. coli isolates from children and adults with UTIs have varying susceptibility patterns to different antibiotics, emphasizing the need for antimicrobial susceptibility testing to guide treatment decisions.