What antibiotic should a patient be discharged with after being treated with Rocephin (Ceftriaxone) for a urinary tract infection (UTI) in the hospital?

From the Guidelines

For a patient being discharged after receiving Rocephin (ceftriaxone) for a UTI in the hospital, the most appropriate oral antibiotic to discharge with would be nitrofurantoin (Macrobid 100mg twice daily) for 5 days, as recommended by the American College of Physicians 1. This recommendation is based on the guidelines outlined by the Infectious Diseases Society of America (IDSA) and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID), which suggest that short-course antibiotics with either nitrofurantoin for 5 days, trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days, or fosfomycin as a single dose are effective for treating uncomplicated bacterial cystitis in women 1. The choice of antibiotic should be based on urine culture results and antibiotic susceptibility testing, as well as patient factors like allergies, kidney function, and pregnancy status. Some key points to consider when selecting an antibiotic include:

• The prevalence of resistance of community uropathogens to fluoroquinolones, which may exceed 10% in some areas 1
• The potential for collateral damage with second-line agents, which may be more likely to produce resistance and side effects 1
• The importance of completing the full course of antibiotics to ensure complete eradication of the infection, even if symptoms improve 1 Patients should be advised to drink plenty of fluids and follow up if symptoms persist or worsen after completing treatment. It is also important to note that fluoroquinolones like ciprofloxacin should be reserved for cases where other options are not suitable due to resistance concerns and side effect profiles 1.

From the Research

Discharge Antibiotics for UTI

If a patient is on Rocephin (ceftriaxone) for a urinary tract infection (UTI) in the hospital, the following antibiotics can be considered for discharge:

• Nitrofurantoin 2, 3, 4, 5, 6
• Amoxicillin-clavulanate 2, 3, 5, 6
• Cefpodoxime 3
• Fosfomycin 2, 4
• Pivmecillinam 2

Considerations

When selecting discharge antibiotics, consider the following:

• Local susceptibility patterns 2, 3, 5, 6
• Patient-specific factors, such as allergy history and renal function 4
• Resistance rates of common uropathogens in the region 5, 6

Antibiotic Resistance

Be aware of high resistance rates to certain antibiotics, including:

• Trimethoprim-sulfamethoxazole 2, 5, 6
• Fluoroquinolones (e.g., ciprofloxacin, levofloxacin) 2, 5, 6
• Cephalexin 5, 6