Three days after a honeymoon in Italy, a healthy 23yr-old woman reports to ED due to a strong pain on urination, fever - 38.5°C and smelly urine. A urine test showed >500 leucocytes/µL. Weight - 54 kg, Height 1.56 m. No renal or hepatic impairments.
Copied of Dr. Crislip's page:
"The following approaches have the same outcomes: empirical antibiotics; empirical delayed (by 48 hours) antibiotics; or targeted antibiotics based on a symptom score (two or more of urine cloudiness, urine smell, nocturia, or dysuria), a dipstick result (nitrite or both leukocytes and blood), or a positive result on midstream urine analysis (PubMed)."
Primary empiric therapy:
Nitrofurantoin macrocrystals, 100 mg twice daily for 5 days (with meals).
TMP/Sulfa, 160 mg and 800 mg twice daily for 3 days.
nitrofurantoin, cephalosporins, and penicillin/betalactams are the best options for therapeutic treatment because of the presence of a rate of resistance to cotrimoxazole and fluoroquinolones of over 10%.
while the most active drug against Pseudomonas aeruginosa was piperacillin/tazobactam.(based on a study conducted on UTI patients in itlay) (pubmed)
leon and Kumar thanks for your answer. on use of nitrofuratoin emperically. most contries in developing world have no labs to test for culure.
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