Important: Therapy
Trimethoprim oral 200mg 12 hourly (3 days)
or
Nitrofurantoin oral 100mg MR 12 hourly (3 days)
Urinary Tract Infection
Duration
See under infection type
Important: Therapy
Trimethoprim oral 200mg 12 hourly (7 days)
or
Nitrofurantoin oral 100mg MR 12 hourly (7 days)
Important: Therapy
Initial treatment
Amoxicillin 1g IV 8 hourly
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.
Second line: Ciprofloxacin oral 500mg 12 hourly. Consider giving initial dose as 400mg IV.
Adjust therapy on basis of culture results or discuss with microbiology.
Total duration (IV&oral) = 7 days then review.
In Pregnancy, see Specialist Obstetric Guideline via NHSB Intranet.
Important: Therapy
Catheter Specimens
In catheterised patients, the bladder quickly becomes colonised. Microscopy and/or “dip-stick” testing is unhelpful as WBC, rbc, nitrate and protein may all be positive when the bladder is colonised.
Catheter urine samples should be sent for culture and sensitivities only if patient is febrile or systemically unwell and bladder is the likely source.
If possible, remove catheter. Treat only if systematically unwell. If treating, the catheter should be changed.
Changing of long term urinary catheter
- Where patients have previously developed sepsis related to changing a long-term urinary catheter, prophylaxis may be considered.
- Previously documented antimicrobial resistance should be considered when choosing an appropriate antimicrobial.
- The following suggestions are made for empirical use in the absence of antimicrobial resistance information.
First choice
Gentamicin
Dose: 3 mg/kg (lean body weight) up to a maximum of 320 mg IV single dose
or
Second choice
Trimethoprim
Dose: 200mg orally single dose
Initial treatment of CAUTI
Amoxicillin 1g IV 8 hourly
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.
Penicillin Allergy
Vancomcin IV (Dosing as per guideline. Use vancomycin calculator.)
Plus
Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.
Adjust therapy on basis of culture results or discuss with microbiology.
Total duration (IV&oral) = 7 days then review
Important: Therapy
First line: Ciprofloxacin oral 500mg 12 hourly for 14 days. Reassess at 14 days, if symptoms completely resolved stop otherwise complete 28 days total.
or
Second line. Only if urine culture shows sensitivity: Trimethoprim oral 200mg 12 hourly for 14 days
Review antibiotic treatment after 14 days and either stop antibiotics or continue for a further 14 days if needed (based on
assessment of history, symptoms, clinical examination, urine and blood tests).
Chronic Prostatitis requires investigation before antimicrobials are started; only 10% of cases are caused by infection
Important: Notes
Whenever possible, a specimen of urine should be collected for culture and sensitivity testing before starting antibacterial therapy. The therapy should reflect current local antibacterial sensitivity patterns.
In general asymptomatic bacteriuria in the elderly should not be treated with antibiotics. “Dip-stick” results are only helpful in MSU.
Remember genital tract sites e.g. vagina, prostate, may give rise to WBC on specimen microscopy.
Please contact a Nephrologist immediately if a kidney transplant patient is found to have a urinary tract infection.
Nitrofurantoin is contraindicated in patients with an eGFR<45ml/min. A short course (3-7days) may be used with caution in certain patients with an eGFR of 30-44ml/min. Only prescribe to such patients to treat lower UTI if indicated by Microbiology results and only if potential benefit outweighs risks.
Trimethoprim should be used with caution in patients with eGFR less than 30mL/min/1.73m2, refer to BNF for dose adjustments in renal impairment.
Fluroquinolones
Refer to important safety information for all quinolones prior to prescribing.
See MHRA Drug Safety Update January 2024: Fluoroquinolones must only be used in situations when other antibiotics, that are commonly recommended for the infection, are inappropriate such as:
- there is resistance to other first-line antibiotics recommended for the infection
- other first-line antibiotics are contraindicated in an individual patient
- other first-line antibiotics have caused side effects in the patient requiring treatment to be stopped
- treatment with other first-line antibiotics has failed