Antibiotics in UTI: GOI Guidelines

A urinary tract infection (UTI) is an infection that affects part of the urinary tract and a common disease encountered by physicians in the course of their work. Correct Prescriptions of Antibiotics ( Antimicrobials) play a very important role in treatment if the disease

In 2016, National Centre For Disease Control , Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India came out with National Treatment Guidelines for Antimicrobial Use in Infectious Diseases.

Following are major recommendation for Urinary Tract Infections:

Condition	Likely Causative Organisms	Empiric antibiotics (presumptive antibiotics)	Alternative antibiotics	Comments
Acute uncomplicated Cystitis	E.coli, Staphylococcus saphrophyticus(in sexually activeyoungwomen), Klebsiella pneumoniae	Nitrofurantoin 100 mg BD for 7 days or Cotrimoxazole 960mg BD for 3-5 days or Ciprofloxacin 500 mg BD for 3-5 days	Cefuroxime 250 mg BD for 3-5 days	Get urine cultures before antibiotics & modify therapy based on sensitivities.
Acute uncomplicated Pyelonephritis	E.coli, Staphylococcus saphrophyticus (in sexually active young women), Klebsiella pneumoniae, Proteus mirabilis	Amikacin 1 g OD IM/IV or Gentamicin 7 mg/kg/day OD (Monitor renal function closely and rationalise according to culture report) Complete total duration of 14 days	Piperacillin-Tazobactam 4.5g IV 6 hourly or CefoperazoneSulbactam 3g IV 12 hourly or Ertapenem 1 g IV OD	Urine culture and susceptibilities need to be collected before starting antimicrobial treatment to guide treatment.
Complicated Pyelonephritis	Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Pseudomonas aeruginosa, Enterococcus sp. Frequently multi-drug resistant organisms are present	Piperacillin-Tazobactam 4.5gm IV 6 hourly or Amikacin 1 g OD IV or Cefoperazone-Sulbactam 3gm IV 12 hourly	Imipenem 1g IV 8 hourly or Meropenem 1gm IV 8 hourly	Get urine cultures before antibiotics & switch to a narrow spectrum agent based on sensitivities. Treat for 10- 14 days. De-escalate to Ertapenem 1 gm IV OD, if Imipenem/meropenem initiated. Monitor renal function if aminoglycoside is used.
Acute prostatitis	Enterobacteriaceae (E.coli, Klebsiella sp.)	Doxycline 100 mg BD or Co-trimoxazole 960 mg BD.	In severe cases, Piperacillin-Tazobactam 4.5gm IV 6 hourly or Cefoperazone-sulbactam 3gm IV 12 hourly or Ertapenem 1 gm IV OD or Imipenem 1g IV 8 hourly or Meropenem 1gm IV 8 hourly	Get urine and prostatic massagecultures before antibiotics & switch to narrow spectrum agent based on sensitivities and then treat total for 3-4 weeks. Use Ciprofloxacin (if sensitive)

Note: Asymptomatic bacteriuria NOT to be treated except pregnant women and immunocompromised patients. All cases of dysuria may not be UTI.

You can read the full Guideline by clicking on the following link :

http://www.ncdc.gov.in/writereaddata/linkimages/AMR_guideline7001495889.pdf