You diagnose a 35 years old woman with uncomplicated cystitis. She is not diabetic and not pregnant. Which antibiotics should you give? What if she had pyelonephritis?
Answer: It depends on your local antibiogram.
San Francisco General Hospital 2010 Antibiogram
Today, go find out about your hospital’s local resistance rates for uropathogens to various antibiotics. For San Francisco General Hospital, I found our antibiogram publicly posted online. Urine isolates of E. coli demonstrate relatively high resistance rates to trimethoprim-sulfamethoxazole and ciprofloxacin:
- Trimethoprim-sulfamethoxazole resistance rate = 33%
- Cefazolin or Cephalexin resistance rate = 12%
- Ciprofloxacin resistance rate = 16%
So based on the new 2010 practice guidelines by the ID Society of America and the European Society for Microbiology and Infectious Diseases,1 I should give:
- Cystitis: Nitrofurantoin x 5 days, or cephalexin / beta-lactam x 3-7 days
- Pyelonephritis: Ceftriaxone 1 gm IV x 1 + (ciprofloxacin x 7 days or trimethoprim-sulfamethoxazole x 14 days)
PV Card: Antibiotics for Uncomplicated Cystitis and Pyelonephritis in Women
Adapted from  Go to ALiEM (PV) Cards for more resources.
- Gupta K, Hooton T, Naber K, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103-20. [PubMed]