What is the treatment for a complicated Urinary Tract Infection (UTI)?

From the Guidelines

For complicated urinary tract infections (UTIs), the recommended treatment is a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, as empirical treatment, with consideration of the patient's specific condition and local resistance rates 1. When managing complicated UTIs, it is essential to consider the severity of the infection, the presence of systemic symptoms, and any underlying urological abnormalities.

• The European Association of Urology guidelines recommend using a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, as empirical treatment for complicated UTI with systemic symptoms 1.
• For patients who do not require hospitalization and have a low risk of resistance, ciprofloxacin may be considered as an option, but only if the local resistance rate is <10% 1.
• It is crucial to manage any underlying urological abnormalities and complicating factors to ensure effective treatment and prevent recurrence 1.
• Recent studies have shown that short-duration courses of antibiotics (5-7 days) can be as effective as long-duration courses (10-14 days) for complicated UTIs, including pyelonephritis, although more data are needed to confirm this in men 1.
• The choice of antibiotic should be guided by the patient's specific condition, local resistance rates, and the severity of the infection, with consideration of the potential risks and benefits of each treatment option.

From the FDA Drug Label

14.7 Complicated Urinary Tract Infections: 5 Day Treatment Regimen To evaluate the safety and efficacy of the higher dose and shorter course of levofloxacin, 1109 patients with cUTI and AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from November 2004 to April 2006 comparing levofloxacin 750 mg I.V. or orally once daily for 5 days (546 patients) with ciprofloxacin 400 mg I.V. or 500 mg orally twice daily for 10 days (563 patients).

14.8 Complicated Urinary Tract Infections: 10 Day Treatment Regimen To evaluate the safety and efficacy of the 250 mg dose, 10 day regimen of levofloxacin, 567 patients with uncomplicated UTI, mild-to-moderate cUTI, and mild-to-moderate AP were enrolled in a randomized, double-blind, multicenter clinical trial conducted in the U.S. from June 1993 to January 1995 comparing levofloxacin 250 mg orally once daily for 10 days (285 patients) with ciprofloxacin 500 mg orally twice daily for 10 days (282 patients).

1.9 Complicated Urinary Tract Infections: 5 Day Treatment Regimen 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)].

1.10 Complicated Urinary Tract Infections: 10 Day Treatment Regimen 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)].

Treatment for complicated UTI:

• Levofloxacin 750 mg orally once daily for 5 days is a recommended treatment regimen for complicated urinary tract infections (cUTI) due to Escherichia coli, Klebsiella pneumoniae, or Proteus mirabilis 2.
• Levofloxacin 250 mg orally once daily for 10 days is also a recommended treatment regimen for complicated urinary tract infections (mild to moderate) due to Enterococcus faecalis, Enterobacter cloacae, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, or Pseudomonas aeruginosa 2.
• The key points to consider when choosing a treatment regimen are:
  • The severity of the infection
  • The causative pathogens
  • The patient's medical history and current condition
  • The potential risks and benefits of each treatment option 2

From the Research

Treatment Options for Complicated UTI

• Levofloxacin is a fluoroquinolone antibacterial that can be used to treat complicated urinary tract infections (UTI) and acute pyelonephritis (AP) 3.
• A high-dose (750 mg) short-course (5 days) of once-daily levofloxacin is approved for use in the US for the treatment of complicated UTI and AP 3.
• Ciprofloxacin is another fluoroquinolone that can be used to treat complicated UTI and acute uncomplicated pyelonephritis (AUP) 4, 5.
• Extended release ciprofloxacin (1,000 mg once daily) has been shown to be as safe and effective as conventional treatment with 500 mg ciprofloxacin twice daily for 7 to 14 days in adults with complicated UTI or AUP 4.

Comparison of Levofloxacin and Ciprofloxacin

• A systematic review and meta-analysis found no significant difference between levofloxacin and ciprofloxacin in terms of end-of-therapy and posttherapy clinical success rate, microbial eradication rate, and adverse event rate for the treatment of UTIs 6.
• However, one study suggested that levofloxacin may be superior to ciprofloxacin for the treatment of E. coli-induced chronic bacterial prostatitis (CBP), but further study is needed to confirm this hypothesis 6.

Other Treatment Considerations

• The choice of antibiotic should be based on the antibiotic sensitivity pattern of the infecting organism and the pharmacokinetics and side-effects of the antibiotic 7.
• Fluoroquinolones, such as levofloxacin and ciprofloxacin, are generally well-tolerated and effective against a wide range of bacterial pathogens, but their use should be considered carefully to minimize the potential for resistance selection 3, 5.