From the Guidelines
For inpatient UTI treatment, empiric therapy with an intravenous third-generation cephalosporin, such as ceftriaxone, is recommended as the first-line treatment, as suggested by the European Association of Urology guidelines 1. This approach is based on the most recent and highest quality evidence available, which prioritizes the use of third-generation cephalosporins for empirical treatment of complicated UTIs with systemic symptoms. Some key points to consider when treating inpatient UTIs include:
- Using a combination of antibiotics, such as amoxicillin plus an aminoglycoside or a second-generation cephalosporin plus an aminoglycoside, as recommended by the European Association of Urology guidelines 1.
- Avoiding the use of ciprofloxacin and other fluoroquinolones for empirical treatment of complicated UTI in patients from urology departments or when patients have used fluoroquinolones in the last 6 months, as recommended by the European Association of Urology guidelines 1.
- Managing any urological abnormality and/or underlying complicating factors, as recommended by the European Association of Urology guidelines 1.
- Considering the treatment duration, which typically ranges from 7-14 days depending on the severity of the infection, with 7 days sufficient for uncomplicated cases and 10-14 days for complicated infections or pyelonephritis, as suggested by the guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults 1.
- Adjusting therapy based on culture results, local resistance patterns, and patient factors such as renal function and allergies, and ensuring adequate hydration and monitoring for symptom improvement, typically expected within 48-72 hours of appropriate therapy.
From the FDA Drug Label
Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis [see Clinical Studies (14.7)]. Levofloxacin tablets are indicated for the treatment of complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa [see Clinical Studies (14.8)]. Levofloxacin tablets are indicated for the treatment of acute pyelonephritis caused by Escherichia coli, including cases with concurrent bacteremia [see Clinical Studies (14.7,14.8)].
Levofloxacin can be used as an antibiotic for inpatient UTI, specifically for complicated urinary tract infections and acute pyelonephritis caused by certain bacteria, including Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis 2.
Gentamicin Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the following microorganisms: Pseudomonas aeruginosa, Proteus species (indole-positive and indole-negative), Escherichia coli, Klebsiella-Enterobacter-Serratia species, Citrobacter species and Staphylococcus species (coagulase-positive and coagulase-negative)
Gentamicin can also be used as an antibiotic for inpatient UTI, specifically for serious infections caused by susceptible strains of certain bacteria, including Escherichia coli and Pseudomonas aeruginosa 3.
From the Research
Antibiotic Treatment for Inpatient UTI
- 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 4.
- High rates of resistance for trimethoprim-sulfamethoxazole and ciprofloxacin preclude their use as empiric treatment of UTIs in several communities, particularly if patients who were recently exposed to them or in patients who are at risk of infections with extended-spectrum β-lactamases (ESBLs)-producing Enterobacteriales 4.
- Second-line options include oral cephalosporins such as cephalexin or cefixime, fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 4.
- For ESBL-producing Enterobacterales urinary tract infections (UTIs), cefepime or piperacillin/tazobactam can be used as an alternative to carbapenems, with similar clinical cure rates and no differences in secondary outcomes such as in-hospital mortality, recurrence, and resistance emergence 5.
- Cefepime/enmetazobactam has been shown to be noninferior to piperacillin/tazobactam for the treatment of complicated UTIs or acute pyelonephritis, and may be considered as a potential empirical therapy for resistant gram-negative infections 6.
- The combination of a beta-lactam (such as cefepime or piperacillin/tazobactam) with an aminoglycoside or a fluoroquinolone (such as ciprofloxacin or levofloxacin) has been shown to be effective against Pseudomonas aeruginosa, with no statistical difference in the frequency of synergy between the beta-lactam plus gentamicin and the beta-lactams plus either ciprofloxacin or levofloxacin combinations 7.