2. Table 1. Risk factors for Complicated UTI Hospital acquired infection Indwelling urinary catheter Recent urinary tract infection Recent urinary tract instrumentation (in the past 2 weeks) Functional or anatomic abnormality of the urinary tract Recent antimicrobial use (in the past 2 weeks) Symptoms for >7 days at presentation Diabetes mellitus Immunosuppression
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4. Do Urine C/S & change antibiotics empirically pending urine C/S results Healthy non-pregnant woman with dysuria, frequency or hematuria Treat empirically with 3 day course of antibiotics (Table 4) Reassess on Day 3 Symptoms improved on Day 3? 1 2 3 4 Do urine D/S & change antibiotics empirically pending urine C/S results 7 Symptoms completely resolved on Day 3? No further treatment 5 6 Y Y Continue Antibiotics for 7 days Symptoms completely resolved on Day 7? 8 9 Manage as complicated UTI. Go to section VI No further treatment 10 11 N N Y N
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9. Table 6 Empiric Treatment regimens for uncomplicated acute pyelonephritis Antibiotic and Dose Frequency and Duration ORAL Ofloxacin 400 mg Ciprofloxacin 500 mg Gatifloxacin 400 mg Levofloxacin 250 mg Cefixime 400 mg Amoxicillin-clavulanate 625 mg (when Gram stain shows Gram positive organisms) BID; 14 BID; 7-10 days OD; 7-10 days OD; 7-10 days OD; 14 days BID; 10-14 days TID; 14 days Parenteral (given until patient is afebrile) Ceftriaxone 1-2 g Ciprofloxacin 200-400 mg Levofloxacin 250-500 mg Gatifloxacin 400 mg Ampi-sulbactam 1.5 g (when Gram stain shows Gram positive organisms) Piperacillin-tazobactam 2.25-4.5 g Q 24 Q 12 Q 24 Q 24 Q 6 Q 6-8
