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5/26/22 cb ADULT Single Dose Aminglycoside for UTI Policy
June 6, 2022

From: "Caitlin Bowman" <caitlin.bowman@hhsys.org>
To: "Pharmacists" <grp_allpharm@hhsys.org>
Cc: "Madeline Belk" <madeline.belk@hhsys.org>, "Jonathan Edwards" <jonathan.edwards@hhsys.org>
Sent: Thursday, May 26, 2022 9:56:13 AM
Subject: ADULT Single Dose Aminglycoside for UTI Policy

Good morning Pharmacists!
 
As you are all aware, UTIs are a common indication for antibiotic prescribing in both inpatient and outpatient settings. These infections are often caused by Enterobacterales and other Gram-negative organisms to which resistance to first line agents (including fluoroquinolones) is increasing. Aminoglycosides are an ideal drug class for UTI therapy as they are excreted in high concentrations in the urine and typically cover resistant organisms (ESBLs, AmpC producers, carbapenem-resistant Enterobacterales, and multi-drug resistant Pseudomonas). Urine concentrations of aminoglycosides exceed plasma concentrations by up to 100-fold within an hour after IV administration and will also remain above therapeutic levels for ~ 72 hours or more. 
 
Due to these pharmacokinetic parameters, a systematic review was performed to evaluate the use of single-dose aminoglycoside therapy for UTIs. Some results from the study include:
  • Microbiologic cure rates were observed from 87-100%
  • Majority of patients experiences no recurrence of infection within 30 days
  • No major adverse effects were identified
The results of this review showed that single-dose aminoglycoside therapy is advantageous as the need for patient adherence is minimal and it eliminates the need for extended inpatient stays for treatment of resistant uropathogens. Based off of this, AMT has created an "ADULT Single-Dose Aminoglycoside Therapy for Urinary Tract Infections" policy for use. Patients who present with an uncomplicated lower tract infection (cystitis) and a documented resistant organism may be a candidate for single-dose aminoglycoside therapy. Exclusions include those with urosepsis/bacteremia, previous infection with an aminoglycoside resistant organism, high risk of Enterococcus spp. infection, chronic renal insufficiency, or an allergy to aminoglycosides. Patients who are eligible will receive a one-time dose of either gentamicin 5 mg/kg or tobramycin 5 mg/kg. Dosing should be based off of the appropriate dosing weight (included in the policy).
 
The full policy can be found on the Antimicrobial Stewardship FormWeb page under "guidelines". This is a great alternative for eligible patients to receive treatment for multi-drug resistant organisms and help avoid prolonged hospital stays. Please reach out to AMT with any questions!






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