Guidelines%20for%20antimicrobial%20therapy%20of%20urinary%20tract%20infections%20in%20Taiwan%20Infectious%20Diseases%20Society%20of%20the%20Republic%20of%20China,%20Medical%20foundation%20in%20Memory%20of%20Dr.%20Deh-Lin%20Cheng,%20Foundation%20of%20Professor%20Wei-Chuan%20Hsieh%20for%20Infectious%20Diseases%20Research

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Guidelines for antimicrobial therapy of urinary
tract infections in TaiwanInfectious Diseases
Society of the Republic of China, Medical
foundation in Memory of Dr. Deh-Lin Cheng,
Foundation of Professor Wei-Chuan Hsieh for
Infectious Diseases Research and Education, Lee
CYs Research Foundation for Pediatric Infectious
Diseases and Vaccine200033271-272 J Microbiol
Immunol Infect
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• A consensus conference for establishing
  guidelines for antimicrobial therapy of urinary
  tract infections in Taiwan was held on March 11,
  2000, following a symposium on urinary tract
  infections(UTIs) held in conjunction by the
  Infectious Diseases Society of the Republic of
  China(IDSROC),
• the Medical Foundation in Memory of Dr. Deh-Lin
  Cheng,

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• Foundation of Professor Wei-Chuan Hsieh for
  Infectious Diseases Research and Education, and
• Lee CYs Research Foundation for Pediatric
  parties to this consensus conference included
  board members of the IDSROC, and
• experts in the field of infectious disease.

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• This is the second consensus conference of this
  nature, and abided b the three principles
  established during the first consensus conference
  on antimicrobial therapy of pneumonia in Taiwan,
  held in 1999
• 1.Establishment of guidelines from the viewpoint
  of primary care physicians.
• 2.Antimicrobial agents recommended in the
  guidelines were agents already marked in Taiwan.
• 3.Guidelines were based on academic principles
  rather than the regulations of the Bureau of
  Natonal Health Insurance on antibiotic usage.

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• In addition, the following two points were also
  considered
• 1.Guidelines were tailored to the local
  epidemiology, including commonly seen pathogens
  and antimicrobial resistance patterns.
• 2.Guidelines included recommendations on
  prophylactic antimicrobial usage.

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• Treatment guidelines were passed through the
  board of IDSROC, and a copy was sent to primary
  care physicians, in the hope fensuring
  appropriate use of antimicrobial agents in the
  community.
• These treatment guidelines were published as a
  supplement in the Journal of Immunology,
  Microbiology and Infection, to serve as a
  reference to all practicing physicians in Taiwan.

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Guidelines for antimicrobial therapy of urinary
tract infections
Diagnosis Drug of choice Alternative choice
Asymptomatic bacteriuria Nitrofurantoin 1o or 2o cephalosporins Trimethoprimb Trimethoprim/sulfamethoxazoleb Ampicillin or amoxicillinc Ampicillin/sulbactamc amoxicillin/clavulanatec
Acute bacterial cystitis Nitrofurantoin 1o or 2o cephalosporins Trimethoprim Trimethoprim/sulfamethoxazoleb Quinolonesd Ampicillin or amoxicillinc Ampicillin/sulbactamc Amoxicillin/clavulanatec Fluoroquinolonese
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Guidelines for antimicrobial therapy of urinary
tract infections
Diagnosis Drug of choice Alternative choice
Acute uncomplicated pyelonephritis Trimethoprim/sulfamethoxazole 1o or 2o cephalosporins Aminoglycosides Ampicillin or amoxicillinc Ampicillin/sulbactamc Amoxicillin/clavulanatec Aminoglycosides(single) 1o or 2o cephalosporins
Acute complicated pyelonephritis/ emphysematous pyelonephritis/renal and perinephric abscess 1o or 2o cephalosporins or ampicillin or amoxicillinAminoglycosides Trimethoprim/sulfamethoxazole 3o or 4o cephalosporins Ticarcillin/clavulanate Piperacillin/tazobactam Aztreonam Imipenem or meropenem Fluoroquinolonese
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Diagnosis Drug of choice
Alternative choice
Acute bacterial prostatitis Ampicillin or amoxicillin 3o cephalosporins Trimethoprim/sulfamethoxazole Fluoroquinolonese
Chronic bacterial prostatitis Trimethoprim/sulfamethoxazole Fluoroquinolones
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Diagnosis Drug of choice
Alternative choice
Nosocomial/catheter-related UTIs 3o or 4o cephalosporins Ureidopenicillins Fluoroquinolonese Ampicillin or amoxicillinf Aminoglycosides Imipenem or meropenem
UTIs in pregnancy Ampicillin or amoxicillinc Nitrofurantoin 1o or 2o cephalosporins 3o or 4o cephalosporins Ureidopenicillins
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Diagnosis Drug of choice
Alternative choice
UTIs in children Ampicillin or amoxicillinc or 1o or 2o cephalosporins Aminoglycosides Trimethoprim/sulfamethoxazole 3o or 4o cephalosporins
Suppressive recurrent UTIs Nitrofurantoin Trimethoprim Trimethoprim/sulfamethoxazole
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• Consensus Conference Participants (in
  alphabetical order)
• Feng-Yee Chang, Shan-Chwen Chang, Yao-Shen
  Chen, Ming-Yuan Chou, Mong-Ling Chu, Chang-Phone
  Fung, Wei-Chuan Hsieh, Po-Ren Hsueh, Clement C.S.
  Hsu, Cheng-Hua Huang, Fu-Yuan Huang, Kun-Yen
  Huang, Yhu-Chering Huang, Chien-Ching Hung,
  Kao-Pin Hwang, Chi-Kan Lan, Yeu-Jan Lau, Cheng-Yi
  Liu, Ching-Chuan Liu, Yung-Ching Liu, Kwen-Tay
  Luh, Fu-Der Wang, Lih-Shinn Wang, Wing-Wai Wong,
  Muh-Yong Yen, Kwok-Woon Yu.

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Dosage of Quinolones in Patients with normal and
reduced renal function
Norrnal Renal Function Norrnal Renal Function Norrnal Renal Function
Quinolone Oral Intravenous
Nalidixic acid 500-1000mg q6h -
Cinoxacin 250mg q6h -
Norfloxacin 400mg q12h -
Ciprofloxacin 250-750mg q12h 200-400mg q12h
Ofloxacin 200-400mg q12h 200-400mg q12h
Pefloxacin 400mg q12h 400mg q12h
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Dosage of Quinolones in Patients with normal and
reduced renal function
Norrnal Renal Function Norrnal Renal Function Norrnal Renal Function
Quinolone Oral Intravenous
Enoxacin 200-400mg q12h -
Lomefloxacin 400mg q24h -
Sparfloxacin 400mg loading dose,then 200mg q24h -
Levofloxacin 500mg q24h 500mg q24h
Grepafloxacin 400-600mg q24h -
Trovafloxacin 200-300mg q24h 200-300mg q24h
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Available b-lactamase inhibitors and b-lactam
antibiotic combinations
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The major Cephalosporins
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