What antibiotics are recommended for a suspected suprapubic catheter-associated urinary tract infection (UTI) in a patient with a penicillin allergy after swimming in a lake?

From the Guidelines

For a suspected suprapubic catheter-associated urinary tract infection (UTI) in a patient with a penicillin allergy after swimming in a lake, I recommend empiric treatment with trimethoprim-sulfamethoxazole (TMP-SMX) 160/800 mg (one double-strength tablet) orally twice daily for 14 days, as it is an appropriate choice for therapy if the uropathogen is known to be susceptible 1.

Key Considerations

• Before starting antibiotics, obtain a urine culture from the catheter to guide definitive therapy.
• If the patient has signs of systemic infection (fever, chills, hypotension), they should seek immediate medical attention as intravenous antibiotics may be necessary.
• For penicillin-allergic patients, other options include nitrofurantoin 100 mg orally four times daily for 7 days (if kidney function is normal) or levofloxacin 500 mg orally daily for 7 days.
• Lake water contains various gram-negative bacteria that can colonize catheters, including Pseudomonas and Enterobacteriaceae, which these antibiotics target effectively.

Prevention and Follow-up

• After treatment, consider changing the suprapubic catheter to remove the biofilm that may have formed.
• In the future, covering the catheter site with a waterproof dressing before swimming can help prevent infections.
• It is essential to be aware of the local community's resistance patterns, particularly fluoroquinolone resistance, when selecting an antimicrobial agent 1.

From the FDA Drug Label

For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and Proteus vulgaris The following organisms are usually susceptible: Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis and indole-positive Proteus species including Proteus vulgaris Ciprofloxacin is indicated for the treatment of complicated urinary tract infections and pyelonephritis due to Escherichia coli

For a patient with a penicillin allergy and a suspected suprapubic catheter-associated urinary tract infection (UTI), the recommended antibiotics are:

• Trimethoprim-sulfamethoxazole 2 2
• Ciprofloxacin 3 These antibiotics are effective against common urinary tract pathogens, including Escherichia coli, Klebsiella species, Enterobacter species, Morganella morganii, Proteus mirabilis, and Proteus vulgaris. Note: The patient's penicillin allergy does not affect the choice of these antibiotics, as they are not penicillin-based.

From the Research

Antibiotic Recommendations for Suspected Suprapubic Catheter-Associated UTI

In a patient with a penicillin allergy, the following antibiotics are recommended for a suspected suprapubic catheter-associated urinary tract infection (UTI):

• Nitrofurantoin 4
• Fosfomycin tromethamine 4, 5
• Pivmecillinam 4
• Fluoroquinolones (although resistance rates are high) 4, 6, 7
• β-Lactams (such as amoxicillin-clavulanate, but with caution due to penicillin allergy) 4, 5
• Cefepime 4
• Piperacillin-tazobactam 4
• Carbapenems 4

Considerations for Antibiotic Resistance

When selecting an antibiotic, it is essential to consider the high rates of resistance to certain antibiotics, such as:

• Trimethoprim-sulfamethoxazole 4, 6, 5, 8
• Ciprofloxacin 4, 6, 7, 8
• Cefalexin 8
• Ampicillin 8
• Cefuroxime Axetil 8
• Ceftriaxone 8

Factors Associated with Antibiotic Resistance

The following factors are associated with an increased risk of antibiotic resistance:

• Prior UTI caused by a resistant organism 6
• Recent use of fluoroquinolones 6
• Being born outside the US 6
• Having a complicated UTI 6