AlixaRx Blog Empiric Treatment of Urinary Tract Infections – An Opportunity for De-escalation and Avoidance

A review of the empiric treatment of urinary tract infections with levofloxacin or ciprofloxacinIf you are wondering what de-escalation means, you are not alone.  While this is common practice in hospitals with infectious disease experts and onsite pharmacists, it is not common practice in the long-term care setting, but it should be.  If possible broad spectrum antibiotics such as levofloxacin and ciprofloxacin should be de-escalated to a narrower spectrum antibiotic after the culture and sensitivities (C&S) are back.  This process often happens during an antibiotic timeout.  An antibiotic timeout is just like it sounds.  At 48 hours after the decision is made to start an antibiotic for a possible urinary tract infection (UTI), the C&S is back, and antibiotic treatment should be reviewed.  At this time the antibiotic can be discontinued if the urine test is negative, it can be changed if the organism is resistant to the current treatment, and it should also be changed if the organism is sensitive to a narrower spectrum antibiotic. Continuing broad spectrum antibiotics unnecessarily puts your residents at increased risk for adverse effects, including Clostridium difficile (C.diff.) and the spread of multi-drug resistant organisms (MDROs).  Recent FDA warnings recommending against fluoroquinolone (Levaquin/Cipro) use to treat uncomplicated UTIs further strengthens the argument against utilizing them for initial treatment… The post Empiric Treatment of Urinary Tract Infections – An Opportunity for De-escalation and Avoidance appeared first on AlixaRx.