Table 2.

Recommended first-line empiric treatment of urinary tract infection

Uncomplicated*	Complicated, nonsevere	Severe/septic/pyelonephritis†
• Nitrofurantoin PO × 5 days • TMP/SMX PO × 3 days • TMP PO × 3 days • Fosfomycin tromethamine PO × 1 dose	• Cefixime PO × 7-10 days • Amoxicillin-clavulanate PO × 7-10 days • TMP/SMX PO × 7-10 days • Fluoroquinolones‡ PO × 7-10 days	• Ceftriaxone IV ± ampicillin IV • Gentamicin IV ± ampicillin IV If clinically appropriate, may step down to PO therapy to complete 7-14 day course

PO, orally; TMP, trimethoprim; SMX, sulfamethoxazole; IV, intravenously.

^*Longer durations should be considered if relapse (recurrent infection within 4 weeks of treatment completion).

^†The decision of which antibiotic to use should always be based on knowledge of local antimicrobial resistance of Escherichia coli or other gram-negative organisms

^‡Resistance to fluoroquinolones is increasing and has reached unacceptable levels in some regions. Fluoroquinolones should be considered alternatives, rather than first-line, in areas where resistance is high.