Approach to empirical antibiotic choice for UTI in adults

Recommendations for empirical antibiotic therapy for urinary tract infection (UTI) are based on factors including efficacy, convenience, cost, availability, and harms associated with antibiotic use (eg adverse effects in the patient, development of antibiotic resistance; see also Types of adverse effects of antimicrobials).

Empirical therapy choice for UTI is guided by the resistance rates of common pathogens (in particular Escherichia coli) and a consideration of the risk of adverse outcomes from clinical failure. As the prevalence of a pathogen’s resistance to an antibiotic increases, so does the likelihood of treatment failure, which may outweigh the benefits of using a narrower-spectrum drug empirically for serious infections (eg pyelonephritis, prostatitis).

Specific information regarding the rationale for empirical antibiotic choice in adults with UTI is given for:

• UTI caused by multidrug-resistant gram-negative bacteria
• acute cystitis
• oral therapy and intravenous therapy for acute pyelonephritis in nonpregnant adults
• acute pyelonephritis in pregnancy
• sepsis and septic shock from a urinary tract source
• oral therapy and intravenous therapy for acute bacterial prostatitis
• chronic bacterial prostatitis.