Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management

Figures & data

Figure 1 Flow chart for the diagnosis of urinary tract infection in patients with type 2 diabetes mellitus.

Abbreviations: cfu, colony-forming units; UTI, urinary tract infection.

Table 1 First-line antibiotic treatment of urinary tract infection in patients with type 2 diabetes mellitus

Type of urinary tract infection (UTI)	Sex	Antibiotic treatmenta	Route	Dosage	Duration of treatment
Asymptomatic bacteriuria	Men and women	None
Acute cystitis	Women	Nitrofurantoin	PO	100 mg × 2–3/d	5 days
		Fosfomycin	PO	3 g	Single dose
		TMP-SMX	PO	960 mg × 2/d	3 daysb
Complicated lower UTI (including catheter-associated UTI)	Men and women	Ciprofloxacin	PO	250–500 mg × 2/d	7–14 daysc
		Ofloxacin	PO	200 mg × 2/d	7–14 daysc
		TMP-SMX	PO	960 mg × 2/db	7–14 daysc
		Cefuroxime	PO	500 mg × 2/d	7–14 daysc
Uncomplicated pyelonephritis	Women	Ciprofloxacin	IVe	400 mg × 2/d	7 days
		Ciprofloxacin	POd	500 mg × 2/d	7 days
		Ofloxacin	IVe	400 mg × 2/d	7 days
		Ofloxacin	POd	400 mg × 2/d	7 days
		Gentamicin	IVe	5 mg/kg × 1/d	7 days
		Cefuroxime	IVe	750 mg × 3/d	10–14 days
		Cefuroxime	POd	500 mg × 2/d	10–14 days
Complicated pyelonephritis/urosepsis	Men and women	Ciprofloxacin	IVe	400 mg × 2/d	10–14 daysc
		Ofloxacin	IVe	400 mg × 2/d	10–14 daysc
		Gentamicin	IVe	5 mg/kg × 1/d	10–14 daysc
		Amikacin	IVe	15 mg/kg × 1/d	10–14 daysc
		Piperacillin-tazobactam	IVe	4.5 g × 3/d	10–14 daysc
		Ertapenem	IVe	1 g × 1/d	10–14 daysc

Notes:

a Always tailor antibiotic treatment according to urine culture results.

b Use empirically only when local resistance <20%.

c Length of treatment depends on severity of symptoms and patient response.

d Administer oral antibiotics to patients with mild to moderate symptoms that can tolerate oral therapy.

e Switch to oral therapy when patient is improving, clinically stable, and can tolerate oral therapy.

Abbreviations: TMP-SMX, trimethoprim-sulfamethoxazole; PO, per os (oral route); IV, intravenous; d, days; g, gram.