Females in their reproductive years 15-45 often suffer from acute UTI due to sexual activities, short urethra etc. Even UTIs are not uncommon in pregnancy, in which Staphylococcus saprophyticus is often the culprit organism along with other Enterobacteriaceae and Non Fermenters Gram Negative Rods.
Patient presents to the doctor with complaints of difficulty in micturition, increased frequency, lower abdominal pain , febrile paroxysmal spikes with chills & rigor , nausea etc. Routine urine microscopy will often reveal pus cells >20/hpf with or without RBCs presence of which may denote upper UTI or pyelonephritis. Urine Culture sample is asked before initiation of 1st dose of emperical antibiotic so that antibiotics doesnot hamper the growth of offending organism thereby limiting its identification and related antibiogram.
Now comes the talk of the day ..
Which is best antibiotic to select in UTI in females ?
Nitrofurantoin has been the drug of choice in acute uncomplicated cystitis in females as well as children. It's renal tubular secretion is maximum and thereby it attains maximum peak concentration in urine producing optimal therapeutic outcome. Dose is 100 mg twice daily x 7 days for adult females. Common side effects include metallic taste, nausea vomiting, abdominal cramps.
Recently Fosfomycin has emerged as a wonderful drug in treating UTIs in female as it comes as single dose 3 gm sachet to be consumed with 1 glass water which produces execllent therapeutic effect against most of the uropathogens like E.coli, Klebsiella, Proteus etc. Being a Category B drug it is considered safe in pregnancy as well.
However, the final antibiotic should always be selected once the culture sensitivity report ( with data of Minimum Inhibitory Concentration/MIC) is available.
Based on antibiogram either an escalating or deescalating approach is adopted to bring out optimal therapeutic outcome following principles of antibiotic stewardship.