From the Guidelines
A simple and effective antibiotic chart for urethritis should prioritize the most recent guidelines, such as those from the European Association of Urology, which recommend specific antimicrobial regimens based on the pathogen. When creating an easy-to-use antibiotics chart, it's essential to consider the type of infection, likely causative pathogens, and the most appropriate antimicrobial therapy. For urethritis, the chart should include:
- Gonococcal infection: Ceftriaxone 1g i.m. or i.v. as a single dose is the recommended first-line treatment 1
- Non-gonococcal infection (unidentified pathogen): Doxycycline 100mg twice daily for 7 days is a suitable option 1
- Chlamydia trachomatis: Azithromycin 1.0-1.5g as a single dose or Doxycycline 100mg twice daily for 7 days are effective treatments 1
- Mycoplasma genitalium: Azithromycin 500mg on day 1, then 250mg daily for 4 days, with Moxifloxacin 400mg daily for 7-14 days as an alternative in cases of macrolide resistance 1
- Ureaplasma urealyticum: Doxycycline 100mg twice daily for 7 days or Azithromycin 1.0-1.5g as a single dose are recommended 1
- Trichomonas vaginalis: Metronidazole or Tinidazole 2g as a single dose are effective treatments 1 It's crucial to consider patient allergies, local resistance patterns, and potential drug interactions when prescribing antibiotics, and to always follow the most recent and highest-quality guidelines, such as those from the European Association of Urology 1.
From the Research
Easy Antibiotics Chart
The following antibiotics are commonly used to treat urinary tract infections (UTIs):
- Nitrofurantoin: a 5-day course is recommended for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 2
- Fosfomycin tromethamine: a 3-g single dose is recommended for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 2
- Pivmecillinam: a 5-day course is recommended for acute uncomplicated bacterial cystitis in otherwise healthy adult nonpregnant females 2
- Trimethoprim-sulfamethoxazole: although previously used as a first-line treatment, its use is now limited due to high rates of resistance 2, 3
- Fluoroquinolones: can be used as an alternative, but their use should be limited due to the risk of resistance development 2, 4
Second-Line Options
The following antibiotics can be used as second-line options:
- Oral cephalosporins such as cephalexin or cefixime 2
- Fluoroquinolones and β-lactams, such as amoxicillin-clavulanate 2
- Nitrofurantoin, fosfomycin, pivmecillinam, fluoroquinolones, cefepime, piperacillin-tazobactam, and carbapenems can be used to treat UTIs due to AmpC-β-lactamase-producing Enterobacteriales 2
Treatment Options for ESBL-Producing Enterobacteriales
The following antibiotics can be used to treat UTIs due to ESBL-producing Enterobacteriales:
- Nitrofurantoin, fosfomycin, pivmecillinam, amoxicillin-clavulanate, finafloxacin, and sitafloxacin for ESBL-E coli 2
- Pivmecillinam, fosfomycin, finafloxacin, and sitafloxacin for ESBL-Klebsiella pneumoniae 2
- Parenteral treatment options include piperacillin-tazobactam, carbapenems, ceftazidime-avibactam, ceftolozane-tazobactam, aminoglycosides, and fosfomycin 2
Treatment Options for Carbapenem-Resistant Enterobacteriales
The following antibiotics can be used to treat UTIs caused by carbapenem-resistant Enterobacteriales:
- Ceftazidime-avibactam, meropenem/vaborbactam, imipenem/cilastatin-relebactam, colistin, fosfomycin, aztreonam, and cefiderocol 2
Treatment Options for MDR-Pseudomonas spp.
The following antibiotics can be used to treat UTIs caused by MDR-Pseudomonas spp.:
- Fluoroquinolones, ceftazidime, cefepime, piperacillin-tazobactam, carbapenems, ceftolozane-tazobactam, ceftazidime-avibactam, aminoglycosides, and colistin 2