TRATAMENTUL INFECTIILOR URINARE NECOMPLICATE 1.

CISTITA ACUTA NECOMPLICATA LA FEMEI PREMENOPAUZALE SI NEINSARCINATE Diagnostic: simt urinara iritativa(disurie, polakiurie, imperiozitate) fara scurgeri vaginale. Laborator: sumar urina, HLG. Urocultura doar la pielonefrite, simpt persisitenta sau care reapar la 2-4 saptamani de la incheierea trat, sau la femei cu simt atipica. Tratament: Trat. de prima intentie: - Fosfomicina 3g in doza unica - Pivmecilinam 400mg/3 zile - Nitrofurantoin 100mgx2/zi/5 zile Trat in caz de rezistenta: - Cotrimoxazole 160/180mg x2/zi/3 zile - Trimetoprim 200mg/5 zile Antibiotic Fosfomicina - MONURAL plicuri 3g Nitrofurantoin cp 50mg Nitrofurantoin macrocrystal cp 100 mg MACROBID Pivmecillinam 400mg Pivmecillinam 200mg Alternative Ciprofloxacin 250mg (CIPRINOL) Levofloxacina 250 mg (TAVANIC) Norfloxacin 400 mg Ofloxacin 200mg Cefpodoxime proxetil 100mg 250mg/12h 250mg/24h 400mg/12h 200mg/12h 100mg/12h 3 zile 3 zile 3 zile 3 zile 3 zile Doza 3 g doza unica 50 mg/6h 100 mg/12h 400mg/12h 200mg/12h Durata 1 zi 7 zile 5-7 zile 3 zile 7 zile

In caz de rezistenta : Trimetoprim sulfametoxazol 160/180 mg (BISEPTOL) Trimetoprim

160+800mg/12h(ghid) 3 zile 2 x 80+400mg/12h 3 zile 200mg/12h 5 zile

Urmarirea pacientilor: la femei la care simptomele nu dispar sau reapar la 2 saptamani de la incheierea trat antibiotic se va efectua UROCULTURA cu antibiograma. Nu se va efectua urocultura de rutina! 2. PNA NECOMPLICATA LA FEMEI PREMENOPAUZALE, NEINSARCINATE Diagnostic: durere in flanc, greturi, varsaturi, febra(>38 C) sau sensibilitate in unghiul costovertebral. Poate sa lipseasca simptomatologia urinara! Laborator: sumar urina, HLG, Urocultura(>10 UFC/mL).

Imagistica: Eco(exclude obstructia). Daca pacientii se mentin febrili sub trat antibiotic peste 72 h CT, UIV. Tratamentul in PNA usoara si moderata: a) Initial: fluorochinolone- ciprofloxacin, levofloxacin b) Alternative(cefalosporine de gen III) Cefpodoxime proxetil, Ceftibuten c) Aminopenicilina + inhibitor de lactamaza in caz patogen Gram + sensibil d) Aminoglicozid sau carbapenem in caz de rezistenta la fluorochinolone sau E coli producatoare de ESBL (iv pana se demonstreaza sensibilitatea agentului si apoi se trece pe oral 7-14 zile). Tratament de prima intentie Ciprofloxacin 500-750mg/12h 7-10 zile Levofloxacin 250-500mg/24h 7-10 zile Levofloxacin 750mg/24h 5 zile Alternative Cefpodoxime proxetil 200 mg/12h 10 zile Ceftibuten 400mg/24h 10 zile Numai atunci cand agentul patogen este sensibil: Trimetoprim-sulfametoxazol 160+800mg/12h 14 zile 2 x 80+400mg/12h 14 zile Co-amoxiclav(AUGMENTIN) 500+125mg(625) x 3/zi 14 zile Atentie la semnele de sepsis! (internare) Tratamentul in PNA severa: Antibiotic Ciprofloxacin Levofloxacin Levofloxacin Alternative Cefotaxime (CEFOTAX) Ceftriaxona (CEFORT 1sau 2g) Ceftazidime (FORTUM 1 sau 2g) Cefepime Co-amoxiclav (AUGMENTIN) Piperacilina-Tazobactam (TAZOCIN) Gentamicina Amikacina Ertapenem (INVANZ) Imipenem (TIENAM imipenem/cilastatin) Meropenem (MERONEM) Doripenem

Doza 400mg(iv) x 2/24h 250-500mg iv/24h 750mg iv/24h 2g x3 iv/24h 1-2g iv/24h 1-2 g x 3 iv/24h 1-2 g iv/12h 1,5g x3 iv/24h 2,5-4,5g x3 iv /24h 5 mg/kgc/24h iv 15mg/kgc/24h iv 1g iv/24h 0,5/0,5g x3/24h iv 1g x 3/24h iv 0,5g x 3/24h iv

Follow-up: - La femei la care simtomele de PNA nu se diminueaza in 3 zile, sau la care dispar si reapar in primele 2 saptamani se va efectua urocultura cu antibiograma, eco si/sau CT.