From the Guidelines
The treatment of choice for Staphylococcus saprophyticus urinary tract infections is typically trimethoprim-sulfamethoxazole (TMP-SMX) or nitrofurantoin, as these antibiotics have shown good in vitro activity against S. saprophyticus 1. When considering treatment options, it's essential to take into account the local antimicrobial susceptibility patterns, as resistance rates can vary significantly between regions and countries 1.
- The recommended dosage for TMP-SMX is one double-strength tablet (160 mg TMP/800 mg SMX) twice daily for 3-5 days in uncomplicated cases.
- Nitrofurantoin is an effective alternative, given as 100 mg twice daily for 5-7 days.
- Fluoroquinolones like ciprofloxacin may be used in patients with allergies or in areas with high resistance patterns, but their use should be guided by local resistance rates, with a threshold of 10% resistance prevalence 1. Key considerations in treatment include:
- Increased fluid intake to help flush bacteria from the urinary tract
- Potential need for longer courses of antibiotics (7-14 days) and urine culture with susceptibility testing in complicated cases or if symptoms persist after treatment
- Awareness of S. saprophyticus's natural resistance to novobiocin, which can aid in laboratory diagnosis 1.
From the FDA Drug Label
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 treatment of choice for Staphylococcus saprophyticus urinary tract infections (UTIs) is levofloxacin (2).
From the Research
Treatment of Choice for Staphylococcus saprophyticus UTIs
- The treatment of choice for Staphylococcus saprophyticus (S. saprophyticus) urinary tract infections (UTIs) is typically nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or a fluoroquinolone 3.
- However, TMP-SMX-resistant S. saprophyticus has been detected in UTI patients, which may affect the choice of treatment 3.
- Other treatment options for UTIs, including those caused by S. saprophyticus, may include oral cephalosporins, such as cephalexin or cefixime, and fluoroquinolones 4.
- Fluoroquinolones, such as levofloxacin, have been shown to be effective in treating UTIs, including those caused by S. saprophyticus, with a high success rate and good tolerability 5, 6.
- The choice of treatment may depend on various factors, including the severity of the infection, the patient's medical history, and local resistance patterns 4, 7.
Factors Affecting Treatment Choice
- Local resistance patterns and the patient's medical history should be considered when choosing a treatment for S. saprophyticus UTIs 3, 4.
- The increasing resistance of uropathogens to certain antibiotics, such as fluoroquinolones, may affect the choice of treatment 4, 7.
- The use of new antimicrobials and the development of resistance should be carefully managed to ensure effective treatment of UTIs 4.