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Table 1 Pharmacologic Treatment Options for Acute UTI-At a Glance |
|
Agent |
Use(s) |
Dosage |
Adverse effects |
Amoxicillin (Amoxil, Wynox) |
Uncomplicated acute UTI, persistent bacteriuria | Adult/Acute or Persistent 250-500 mg po q8h x 7-10 days | Cross-allergenicity with cephalosporins; urticaria; pruritus; diarrhea |
|
Cephalexin (Keflex) |
Uncomplicated acute UTI | Adult/Acute 500 mg po q12h x 7-10 days | Cross-allergenicity with penicillins; urticaria; pruritus; diarrhea; GI upset; seizures |
|
Fluoroquinolones Ciprofloxacin (Cipro)
|
Uncomplicated & complicated acute UTI in adults only | Uncomplicated: 100 mg po q12h x 3 days. Complicated: 250-500 mg po or IV q12h x 7-10 days | GI distress; CNS symptoms- headache, dizziness, fatigue, insomnia, agitation, restlessness, urticaria; pruritus |
|
Enoxacin (Penetrex) |
Uncomplicated & complicated acute UTI in adults only | Uncomplicated: 200 mg po q12h x 3-7 days. Complicated: 400 mg po q12h x up to 14 days |
Same as above |
|
Norfloxacin (Noroxin) |
Uncomplicated & complicated acute UTI in adults only | Uncomplicated: 400 mg po q12h x 7-10 days. Complicated: 400 mg po q12h x 10-21 days |
Same as above |
|
Ofloxacin (Floxin) |
Uncomplicated & complicated acute UTI in adults only | Uncomplicated: 200 mg po or IV q12h x 3 days or 200 mg po or IV q12h x 7 days. Complicated: 200 mg po or IV q12h x 10 days |
Same as above |
|
Levofloxacin (Levaquin) |
Complicated acute UTI | 250 mg po or IV qd x 10 days |
Same as above |
|
Sulfonamides Sulfamethoxazole (Gantanol; Urobak) |
Uncomplicated acute UTI | Adult Intitial: 2 gm po Adult Maintenance: 1 gm po bid x 3-7 days |
Hypersensitivity-generalized skin eruptions, urticaria, photosensitivity, pruritus, periorbital edema; headaches, nausea & vomitting; abdominal pain; blood dyscrasias |
|
Sulfisoxazole (Gantrisin) |
Uncomplicated acute UTI | Adult Initial: 2-4 gm Adult Maintenance: 4-8 gm/day po in 4-6 divided doses x 3-7 days |
Same as above |
|
Urinary-Specific antiinfectives Cinoxacin (Cinobac) |
Uncomplicated acute UTI, persistent bacteriuria & reinfection in adults; also prophylactic therapy | Adult/Acute: 1 gm/day po, in 2-4 divided doses x 7-14 days. Adult Prophylactic: 250 mg qhs (up to 5 months) |
GI and hypersensitivity symptoms |
|
Methenamine hippurate (Hiprex, Urex) |
Long-term suppression or elimination of bacteriuria | Adult: 1 gm po bid | GI: nausea, vomitting, cramps, anorexia GU: dysuria, frequency, urgency, hematuria, proteinuria, crystalluria |
|
Methenamine mandelate (Mandelamine; Mandemeth) |
Long-term suppression or elimination of bacteriuria | Adult: 1 gm po qid (after meals and at bedtime) | Same as above |
|
Nalidixic acid (NegGram) |
Uncomplicated acute UTI, persitent bacteriuria & reinfection | Adult: 500 mg po q8h x 3 days or 1 gm po qid x 7-14 days (total dose = 4 gm/day) Adult maintenance: 2 gm/day po |
Drowsiness, weakness, headache, dizziness, vertigo, abdominal pain, nausea, vomiting, diarrhea, hypersensitivity, photosensitivity, visual disturbances |
|
Nitrofurntoin (Furadantin, Furalan, Furanite, Nitrofan) Nitrofurntoin Macrocrystalline (Macrodantin) |
Uncomplicated acute UTI, persistent bacteriuria, reinfection & bacteriuria in pregnancy | Adult: 50 mg po q8h x 3 days or 50-100 mg po qid 7-10 days Adult maintenance: 50-100 mg po qhs |
Anorexia, nausea, vomiting; pulmonary fibrosis, peripheral neuropathy, and acute/chronic hepatic injury are serious but rare adverse reactions |
|
Trimethoprim (Proloprim; Trimpex) |
Uncomplicated acute UTI; long-term prophylactic treatment of bacteriuria | Adult/Acute: 300 mg po daily x 3 days; 100 mg po q12h x 3-7 days or 200 mg
po q24h x 10 days Adult/Prophylactic: 100 mg po qhs, ever other night or after intercourse |
Rashes, pruritus, exfoliative dermatitus, epigastric distress, nausea, vomiting, thrombocytopenia |
|
Trimethoprim and sulfamethoxazole; co-trimoxazole; TMP-SMZ (Bactrim, Cotrim, Septra, Sulfatrim, Uroplus) |
Uncomplicated acute UTI, persistent bacteriuria, reinfection & long-term prophylactic treatment of bacteriuria | Adult/Acute: 2 DS tablets po single dose or 1 DS tablet po q12h x 3 days Adult/Persistent or Reinfection: 1 DS tablet po q12h x 7 days Adult/Prophylactic: 1/2 single strength tablet qhs, every other night, or after intercourse |
Same as for sulfonamides and trimethoprim |
| GI, Gastrointestinal; IV, intravenous; CNS, central nervous system; GU, genitourinary |
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