What is the antimicrobial treatment of complicated UTI?
The treatment of complicated UTI requires consideration of the underlying abnormality and recognition of the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance. When symptoms are mild, antimicrobial therapy should be delayed pending urine culture results so specific therapy can be prescribed. Empiric antimicrobial therapy, when indicated, is selected considering recent antimicrobial therapy, any previous urine culture results, patient tolerance, and kidney function. The antimicrobial should have good urinary excretion and provide coverage for the presumed infecting organism and susceptibility. A fluoroquinolone is often prescribed for empiric therapy. When parenteral therapy is indicated, aminoglycosides (gentamicin, tobramycin) are effective for patients without kidney failure because most gram-negative organisms remain susceptible to these agents. If aminoglycosides cannot be used, an extended spectrum cephalosporin (cefotaxime, ceftriaxone, ceftazidime), penicillin (piperacillin/tazobactam), or carbapenem (meropenem, ertapenem) are other options.
