Females/Healthy Males - First episode
- Screen for pyuria. A negative urinalysis/microscopy for pyuria excludes UTI in most cases.
- Pre-treatment urine culture recommended if:
quinolone or cephalosporin use within last 6 months
previous UTI with Gram negative organism other than E. coli, or with an ESBL or AmpC-producing organism
travel outside Canada/U.S. within last 6 months
recent hospitalization/health care associated
- Routine post treatment urine cultures are not recommended if pyuria, typical symptoms of cystitis and adequate response to therapy.
- Lack of response after 48h of appropriate antibiotic therapy warrants:
urine culture (if not taken pre-treatment),
treatment for pyelonephritis tailored to C&S results if available, and
clinical evaluation for other genitourinary infections, including sexually transmitted infections (STIs).
E. coli
S. saprophyticus
Other Enterobacterales
Organisms that are NOT usual uropathogens in uncomplicated cystitis
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Nitrofurantoin | Macrobid 100mg PO bid or | 5 days |
| 50-100mg PO qid | 5 days | |
| Alternative if creatinine clearance <40 mL/min or intolerance/allergy to nitrofurantoin | ||
| Fosfomycin | 3g PO | 1 dose |
Alternative for 1st time cystitis and no antibiotic exposure within last 6 months
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cephalexin | 250-500mg PO qid | 5-7 days |
| or | ||
| TMP/SMX | 1 DS tab PO bid | 3 days |
| or | ||
| Ciprofloxacin | 250mg PO bid or | 3 days |
| XL 500mg PO daily | 3 days |
Alternative in other patients
| Empiric Therapy | Dose | Duration |
|---|---|---|
| Cefixime | 400mg PO daily | 5-7 days |
| or | ||
| Ciprofloxacin | 250mg PO bid or | 3 days |
| XL 500mg PO daily | 3 days |