Run Time: 4 minutes
Author: Holly Anderson, PharmD PGY-1 Resident
- Patients with pyelonephritis typically show a leukocytosis, fever, nausea, HA, CVA tenderness. Patients with a lower tract UTI will have absence of systemic symptoms with predominantly voiding symptoms of frequency, urgency, dysuria, and hematuria. These 2 types of UTI require different antibiotics and treatment.
- Based on IDSA guidelines, only patients with uncomplicated lower UTI should be receiving Macrobid.
- For patients with uncomplicated pyelonephritis, fluoroquinolones and Bactrim are preferred.
- Macrobid has good sensitivity for the classic bugs that cause UTI, while fluoroquinolones show increasing E. coli resistance and are not recommended for uncomplicated lower tract UTIs.
- Macrobid should not be used for pyelonephritis because the medication penetrates to the bladder just fine, but not well enough to the kidneys.