From the Guidelines
Intravenous (IV) medications for urinary tract infection (UTI) include ceftriaxone.
IV Medications for UTI
- Ceftriaxone is a recommended empirical choice for patients who require intravenous therapy, barring any risk factors for multidrug resistance 1.
- A third-generation cephalosporin, such as ceftriaxone, can be used as empirical treatment for complicated UTI with systemic symptoms 1.
- For severe cases, amikacin or gentamicin can be used, but amikacin is usually more frequently active on Enterobacterales 1.
- An initial intravenous dose of a long-acting parenteral antimicrobial, such as 1 g of ceftriaxone, is recommended if trimethoprim-sulfamethoxazole is used when the susceptibility is not known 1.
Important Considerations
- The choice of IV medication should be based on local resistance rates and the severity of the infection.
- The use of fluoroquinolones, such as ciprofloxacin, should be avoided if the local resistance rate is high 1.
- The treatment regimen should be adjusted based on culture and susceptibility results, and the clinical course of the patient 1.
From the Research
Intravenous Medications for Urinary Tract Infections
The following intravenous (IV) medications have been studied for the treatment of urinary tract infections (UTIs):
- Ciprofloxacin, which has been shown to be effective in the initial empirical management of severe forms of UTI, including bacteremic forms, in patients without severe sepsis, obstruction, or renal foci of suppuration 2
- Tazobactam/piperacillin, which was found to be related to prolongation of antibiotic treatment in complicated acute pyelonephritis (AP) 3
- Fosfomycin, which has been reported to be noninferior to piperacillin-tazobactam in treating patients with complicated upper urinary tract infection (cUUTI) or acute pyelonephritis (AP), including in patients with concomitant bacteremia 4
- Long-acting IV antibiotics, such as those recommended by the Infectious Diseases Society of America guideline, which can improve the likelihood of providing in vitro susceptibility to the isolated uropathogen when the prevalence of fluoroquinolone resistance exceeds 10% 5
Key Findings
- The efficacy of IV antibiotics in treating UTIs has been demonstrated in several studies, with low rates of treatment failure and microbiological failure 2, 4, 6
- The choice of IV antibiotic should be based on the severity of the infection, the presence of underlying urinary tract disease, and the susceptibility of the uropathogen to the antibiotic 3, 5
- Transitioning patients from IV to oral antibiotic therapy can be a successful approach for treating UTIs, with similar rates of treatment failure as those who receive exclusive IV therapy 6