From the Research
Intravenous (IV) vancomycin is the recommended treatment for multidrug-resistant urinary tract infections (UTIs) that are only sensitive to vancomycin, with a standard dosing of 15-20 mg/kg IV every 8-12 hours, adjusted based on renal function and vancomycin trough levels (aim for 15-20 mg/L for serious infections) 1. When considering treatment options for UTIs caused by multidrug-resistant bacteria, it is essential to prioritize the patient's clinical condition, infection severity, and local susceptibility patterns.
- For complicated UTIs or systemic infections, IV vancomycin is typically recommended, as it is effective against vancomycin-sensitive bacteria, despite its poor urinary excretion 1.
- For uncomplicated lower UTIs without systemic symptoms, alternative approaches may be considered, including fosfomycin (3g oral single dose), nitrofurantoin (100mg oral twice daily for 5-7 days if MIC ≤32 μg/mL), or high-dose oral trimethoprim-sulfamethoxazole, depending on local susceptibility patterns 2, 3.
- In some cases, an infectious disease consultation may be warranted to discuss options like intravesical vancomycin instillation (1g vancomycin in 100mL normal saline instilled into the bladder for 60 minutes) for recurrent or persistent UTIs 4, 5. The choice of therapy should be guided by the patient's clinical condition, infection severity, and whether the bacteria represent true infection versus colonization, as asymptomatic bacteriuria often doesn't require treatment except in specific populations like pregnant women or before urologic procedures 2, 3.