급성 신우신염 치료, MDR 감염 위험이 낮은 경우

 

급성 신우신염에 대한 empirical antibiotics...

: 입원한 경우가 아닌 외래 환자에서 경험적 항생제 선택에 대한 내용입니다.

 

Fluoroquinolone에 대한 금기가 없고 이 약제에 대한 내성 위험이 낮은 경우 경구 fluoroquinolone을 경험적 항생제로 투약하며 용량은 ciprofloxacin 500 mg 하루 2회, 1000 mg 하루 1회, levofloxacin 750 mg 하루 1회 투약합니다. 치료 기간은 5-7입니다.

 

■ 퀴놀론 약제를 선택한 경우 치료 기간은 5-7일이다.

■ 퀴놀론을 사용하지 못하는 경우 아목시실린/클라블라네이트, 세프포독심, 세프디니르, 세파드록실을 선택할 수 있으며 치료 기간은 7-10일로 더 길다.

■ 세프트리악손, 어타페넴, 겐타마이신, 토브라마이신은 경구 약제 투약 이전에 1회로 외래에서 투약할 수 있고 ceftriaxone > ertapenem > gentamicin, tobramycin로 선택 순서를 갖는다.

■ 중증도에 따라 치료 기간을 길어질 수 있다.

 

 

Empiric antimicrobial agent selection for acute complicated urinary tract infection

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Patient population	Risk for MDR?*	Empiric regimens	Comments
Outpatients	No, and no concerns with fluoroquinolones (eg, at low risk for adverse effects)	For patients with low risk of fluoroquinolone resistance/toxicity: Ciprofloxacin 500 mg orally twice daily for 5 to 7 days or Ciprofloxacin extended-release 1000 mg orally once daily for 5 to 7 days or Levofloxacin 750 mg orally once daily for 5 to 7 days	If the community prevalence of fluoroquinolone resistance in Escherichia coli is known to be >10%, give one dose of a long-acting parenteral agent prior to the fluoroquinolone: Ceftriaxone 1 g IV or IM once Ertapenem 1 g IV or IM once Gentamicin 5 mg/kg IV or IM once Tobramycin 5 mg/kg IV or IM once
	No, but with concerns with fluoroquinolones (eg, at risk for adverse effects)	For patients who cannot use a fluoroquinolone: One dose of a long-acting parenteral agent: Ceftriaxone 1 g IV or IM once or Ertapenem 1 g IV or IM once or Gentamicin 5 mg/kg IV or IM once or Tobramycin 5 mg/kg IV or IM once Followed by one of the following: TMP-SMX one double-strength tablet orally twice daily for 7 to 10 days or Amoxicillin-clavulanate 875 mg orally twice daily for 7 to 10 days or Cefpodoxime 200 mg orally twice daily for 7 to 10 days or Cefdinir 300 mg orally twice daily for 7 to 10 days or Cefadroxil 1 g orally twice daily for 7 to 10 days	In outpatients who are systemically ill or are at risk for more severe illness, we favor continuing the parenteral agent until culture and susceptibility testing results can guide selection of an appropriate oral agent.
	Yes	Ertapenem 1g IV or IM once Followed by: Ciprofloxacin 500 mg orally twice daily for 5 to 7 days or Ciprofloxacin extended-release 1000 mg orally once daily for 5 to 7 days or Levofloxacin 750 mg orally daily for 5 to 7 days	If the patient cannot take a fluoroquinolone or has high risk for fluoroquinolone resistance (fluoroquinolone-resistant isolate or fluoroquinolone use in prior three months): Ertapenem 1 g IV or IM once daily until cultures and susceptibility testing return

* Risk factors for MDR gram-negative UTIs include any one of the following in the prior three months:

• An MDR, gram-negative urinary isolate, including a fluoroquinolone-resistant Pseudomonas urinary isolate
• Inpatient stay at a health care facility (eg, hospital, nursing home, long-term acute care facility)
• Use of a fluoroquinolone, TMP-SMX, or broad-spectrum beta-lactam (eg, third- or later-generation cephalosporin)
• Travel to parts of the world with high rates of MDR organisms

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Empirical antibiotics : ciprofloxacin 500 mg bid for 10 days...경과가 좋으면 7일까지만 처방하자