RT2- Cystitis and Pyelonephritis

This article discusses the guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women. Women with acute uncomplicated cystitis usually present without fever, flank pain or symptoms of pyelonephritis and are able to take oral medications are treated with Nitrofurantoin (Macrobid) 100 mg for 5 days (also safe in pregnancy) OR Bactrim DS BID for 3 days OR Fosfomycin trometamol 3 gm single dose OR Pivmecillinam 400 mg BID for 5 days. Floroquinolones are also another option.

For acute pyelonephritis, a urinalysis should be performed in order to prescribe the best therapy for the targeted agent. The treatment options are oral ciprofloxacin 500 mg BID for 7 days  OR once daily oral fluoroquinolone — ciprofloxacin 1000 mg extended release for 7 days or levofloxacin 750 mg for 5 days if patient does not require hospitalization. Another option is oral Bactrim 160/800 mg BID for 14 days. Beta Lactams are usually less effective in pyelonephritis treatment. If hospitalization is required, the treatment options consist of IV floroquinolones, amino glycoside, with or without ampicillin, extended spectrum cephalosporin/penicillin or a carbapenem. The patient in my case was treated with Meropenem.

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