Asymptomatic Bacteriuria is treated with antibiotics?

1.

Elsevier ClinicalKey Clinical Overview

Follow-Up ASB is not a static phenomenon In a prospective evaluation of males and females older than age 80 years, those who had persistent bacteriuria at 18 months showed concordance of their original and follow-up strains in 40% of cases. There is likely high turnover of colonizing bacterial populations in the bladder In premenopausal females, ASB frequently spontaneously clears The administration of antibiotics for ASB results in significantly more cases of bacteriologic cure, with a meta-analysis involving 1154 patients showing more than double the bacteriologic eradication rate as compared to no antibiotic therapy (relative risk of 2.67 [95% CI, 1.85-3.85]) In nonpregnant adults, the presence or absence of ASB is not correlated with any long-term adverse effects or increased risk of mortality, and the treatment of ASB does not improve any long-term outcomes Treatment of ASB may increase the risk for symptomatic urinary tract infection in younger females It is hypothesized that antibiotic exposures result in disturbances in the gut and vaginal microbiomes such that there is reduced protection against bacterial overgrowth and persistent colonization with potentially more virulent or resistant strains

Treatment Dose adjustments or use of agents other than those presented in the following text may be necessary in patients with renal impairment (ie, acute kidney injury or chronic kidney disease) Treatment of ASB is indicated in 2 groups: Patients undergoing high-risk urologic procedures Choice of prophylactic agent is dependent upon anatomic site as well as type and duration of instrumentation, and it should consider local resistance patterns as well as patient-specific factors Single-dose antibiotic prophylaxis (oral or IV) administered perioperatively 30 to 60 minutes before procedure will generally treat ASB if present Commonly used options include: Trimethoprim-sulfamethoxazole: 800 mg/160 mg PO once Amoxicillin-clavulanic acid: 875 mg PO once Cefazolin: 2 to 3 g IV once If culture data exist, then culture-directed therapy should be used Patients who are pregnant Treatment of ASB in patients who are pregnant should use antimicrobial agents deemed safe in pregnancy, account for local resistance patterns, and include appropriate gram-negative coverage; β-lactams are generally considered first line and allergies should be investigated before eliminating β-lactams as an available option The optimal treatment duration is unknown Short courses are associated with fewer adverse events There may be improved outcomes with respect to low preterm birth rates with 7-day courses compared to shorter courses A duration of 4 to 7 days is reasonable for most regimens, but this is based on low-quality evidence Options that meet these criteria and include appropriate gram-negative coverage include the following: Cephalexin: 250 to 500 mg PO every 6 hours Amoxicillin: 500 mg PO every 8 hours High rates of resistance; avoid use as first line agent without culture definitive sensitivity Nitrofurantoin: 100 mg PO every 12 hours May be used in the first trimester if no alternative agents are available Rarely, it may cause hemolytic anemia in the fetus or newborn; highest risk is in those with glucose-6-phosphate dehydrogenase deficiency

Treatment May be used in the first trimester if no alternative agents are available Rarely, it may cause hemolytic anemia in the fetus or newborn; highest risk is in those with glucose-6-phosphate dehydrogenase deficiency Trimethoprim-sulfamethoxazole: 800 mg/160 mg PO every 12 hours Avoid in first trimester due to risk of neural tube defects with antifolate therapies; may be used in the first trimester if no alternative agents are available Do not use as first line therapy in areas with reported resistance to trimethoprim-sulfamethoxazole greater than 20% Use with caution after 32 weeks of pregnancy due to increased risk of neonatal jaundice Fosfomycin: 3 g PO once Exception to typical treatment duration for ASB in pregnancy; has shown good efficacy as single-dose treatment

2.

Elsevier ClinicalKey Clinical Overview

Treatment Asymptomatic bacteriuria Treat asymptomatic bacteriuria in patients who are at high risk for complications of bacteriuria (eg, pyelonephritis, bacteremia), including the following patient populations, with or without a catheter in place: Pregnant patients Pregnant patients with asymptomatic bacteriuria are 20 to 30 times more likely to develop pyelonephritis during pregnancy than pregnant patients without bacteriuria Pregnant patients with asymptomatic bacteriuria are also more likely to experience premature delivery and have low-birth-weight infants Screen all pregnant patients in the first trimester with urine culture and treat all identified cases of asymptomatic bacteriuria with antimicrobial therapy guided by culture sensitivities for 4 to 7 days Patients undergoing transurethral resection of the prostate and other urologic procedures that involve mucosal bleeding Screen all patients undergoing urologic surgeries that may result in mucosal bleeding with a urine culture performed several days before the procedure; management requires that antimicrobial sensitivities are available before surgery Treat all urologic surgical patients identified with asymptomatic bacteriuria with an appropriate antibiotic as determined by urine culture sensitivities shortly before the procedure begins A short course (1 or 2 doses), rather than more prolonged antimicrobial therapy, is recommended Treat females with asymptomatic bacteriuria that persists for 48 hours or more after urinary catheter removal Treat for 3 to 7 days with appropriate antibiotics based on culture and sensitivity results Children Catheters are a rare cause of urinary tract infections in children Minimize catheter use whenever possible

3.

Elsevier ClinicalKey Clinical Overview

Screening and Prevention Screening for or treatment of asymptomatic bacteriuria is not recommended in healthy asymptomatic nonpregnant adults Screening for asymptomatic bacteriuria is recommended in all pregnant patients Asymptomatic bacteriuria is common and increases risk of symptomatic urinary tract infection, including pyelonephritis Untreated asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth restriction, low birth weight, maternal hypertension, preeclampsia, and anemia Screen all pregnant patients with urine culture for bacteriuria in the first trimester; benefit of repeated screening is unclear Treat all identified cases of asymptomatic bacteriuria with antimicrobial therapy guided by culture sensitivities for 4 to 7 days Screening for asymptomatic bacteriuria is recommended in patients who will be undergoing endoscopic urologic procedures Screen with urine culture before procedure Treat all identified cases of asymptomatic bacteriuria with 1 to 2 doses of targeted antimicrobial therapy guided by culture sensitivities before the procedure

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Elsevier ClinicalKey Drug Monograph

Content last updated: February 1, 2024.

Indications And Dosage Oral dosage (monohydrate/macrocrystal capsules) Adults: 100 mg PO every 12 hours for 7 days. Oral dosage (suspension and macrocrystal capsules) Adults: 50 to 100 mg PO every 6 hours for 7 days.