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Peds ID Abx QOTW #23 Answer

a) Ciprofloxacin 500mg PO BID x 7 days

b) Ceftriaxone 1gm IV/IM x 1 dose

c) Bactrim DS 1 tab PO BID x 7-14 days

Drug choices in treatment of UTI / Pyelonephritis

  • Nitrofurantoin, TMP/SMX, cephalexin for very young recommended for cystitis (uncomplicated UTI), duration of therapy is age dependent
    • Resistance rates are over-estimated due to urinary concentrations well above MICs
  • Nitrofurantoin not recommended for pyelonephritis
  • Ciprofloxacin x 7 days is recommended for pyelonephritis, but institution dependent based on resistance patterns (20% of E. coli resistant)
    • May cause nausea and vomiting
  • TMP/SMX x 14 days is recommended for pyelonephritis
    • Recent studies suggest 7 days may be sufficient
  • Cephalexin x 10-14 days (3rd line) is recommended for pyelonephritis
    • A first dose of ceftriaxone is recommended if symptoms are more severe given resistance
    • 7 days of therapy is not sufficient for pyelonephritis
  • Fosfomycin – insufficient data that current U.S. formulation is effective enough  for pyelonephritis