Oral Antibiotic Options for Urological and Skin/Soft Tissue Infections
For Urological Procedures and Prophylaxis
Fluoroquinolones are the preferred oral agents for urological prophylaxis, with levofloxacin 500 mg as a single dose being the standard choice 1.
Specific Oral Regimens for Urological Prophylaxis:
- Levofloxacin: 500 mg PO single dose 1
- Ciprofloxacin: 500 mg PO q12h 1
- Ofloxacin: 400 mg PO q12h 1
- Trimethoprim-sulfamethoxazole: 1 double-strength tablet PO q12h 1
First-Generation Oral Cephalosporins:
Second-Generation Oral Options:
- Cefuroxime: 500 mg PO q12h 1
- Cefaclor: 500 mg PO q8h 1
- Cefprozil: 500 mg PO q12h 1
- Amoxicillin/clavulanate: 875 mg PO q12h 1
For Uncomplicated Pyelonephritis
Fluoroquinolones remain first-line oral therapy when local resistance is <10%, with ciprofloxacin 500-750 mg twice daily for 7 days or levofloxacin 750 mg once daily for 5 days 1.
Oral Treatment Options:
- Ciprofloxacin: 500-750 mg twice daily for 7 days 1
- Levofloxacin: 750 mg once daily for 5 days 1
- Trimethoprim-sulfamethoxazole: 160/800 mg twice daily for 14 days (only if fluoroquinolone resistance >10%) 1
- Cefpodoxime: 200 mg twice daily for 10 days 1
- Ceftibuten: 400 mg once daily for 10 days 1
Critical caveat: Nitrofurantoin, oral fosfomycin, and pivmecillinam should be avoided for pyelonephritis as there are insufficient data regarding their efficacy 1.
For MRSA Skin and Soft Tissue Infections
Trimethoprim-sulfamethoxazole (TMP-SMX) is the preferred first-line oral antibiotic for MRSA skin infections, dosed at 1-2 double-strength tablets twice daily for 5-10 days 2, 1.
First-Line Oral Options for MRSA:
- TMP-SMX: 1-2 double-strength tablets (160/800 mg) twice daily 1, 2
- Doxycycline: 100 mg twice daily 1, 2
- Minocycline: 100 mg twice daily 1, 2
- Linezolid: 600 mg twice daily 1
- Tedizolid: 200 mg once daily 1
Dual Coverage Options (MRSA + Streptococci):
- Clindamycin alone: 300-600 mg three times daily 1 (provides coverage for both MRSA and β-hemolytic streptococci)
- TMP-SMX or tetracycline PLUS a β-lactam (e.g., amoxicillin or cephalexin) 1
- Linezolid alone: 600 mg twice daily 1
Important warning: Clindamycin should be avoided if local resistance rates are high (>10%) or if inducible resistance (D-test positive) is present, and carries higher risk of Clostridioides difficile infection 2, 1.
For Non-MRSA Skin and Soft Tissue Infections
For mild skin infections without MRSA risk, amoxicillin-clavulanate, cloxacillin, or cefalexin are first-choice agents 1.
Oral Options for Impetigo and Simple Cellulitis:
- Dicloxacillin: 250 mg four times daily (adults) or 12 mg/kg/day in 4 divided doses (children) 1
- Cephalexin: 250-500 mg four times daily (adults) or 25 mg/kg/day in 4 divided doses (children) 1
- Amoxicillin/clavulanate: 875/125 mg twice daily (adults) or 25 mg/kg/day in 2 divided doses (children) 1
- Clindamycin: 300-400 mg three times daily (adults) or 10-20 mg/kg/day in 3 divided doses (children) 1
For Urethritis
For gonococcal urethritis, oral cefixime 400 mg single dose plus azithromycin 1 g single dose is the oral alternative when intramuscular ceftriaxone is not available 1.
Oral Regimens for Non-Gonococcal Urethritis:
- Doxycycline: 100 mg twice daily for 7 days 1
- Azithromycin: 500 mg on day 1, then 250 mg for 4 days 1
- Levofloxacin: 500 mg once daily for 7 days 1
- Ofloxacin: 200 mg twice daily for 7 days 1
Critical Pitfalls to Avoid
Never use rifampin as monotherapy or adjunctive therapy for skin infections due to rapid resistance development 1, 2.
Beta-lactam antibiotics (penicillins, cephalosporins) are completely ineffective against MRSA and should never be used for suspected MRSA infections 2.
For pyelonephritis, if oral cephalosporins (cefpodoxime or ceftibuten) are used empirically, an initial intravenous dose of a long-acting parenteral antimicrobial (e.g., ceftriaxone) should be administered first 1.
Tetracyclines (doxycycline, minocycline) should not be used in children <8 years of age 1.