Complicated UTI (including urinary sepsis and pyelonephritis)
Gentamicin IV as per protocol AND Amoxicillin 1g IV 8 hourly
If felt hospital admission is not required and no evidence of previous resistance:
Co-amoxiclav 625mg PO 8 hourly or Ciprofloxacin 500mg PO 12 hourly (consider safety issues) or Cefalexin 1.5g PO 8 hourly pending results
If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Temocillin IV dosed per Renal Drug Database
Gentamicin IV as per protocol
AND
Vancomycin IV as per protocol
If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Aztreonam IV dosed per Renal Drug Database
- Notes
UTI + sepsis
OR
Pyelonephritis +/- sepsis
OR
CAUTI + sepsis in men and women
Advice from Urology/Microbiology :- Do not routinely change catheters for simple UTIs. Consider catheter change if severe sepsis or infection not resolving on treatment.
Send blood culture and urine and follow up results
Check previous urine results for guidance
Treatment duration: 7 days
If poor clinical response: review microbiology results, consider complicated infection (e.g. perinephric abscess, obstruction) seek senior clinical review
Oral switch guidance
Review culture results first. If no positive microbiology to guide:
Preferred regime - Co-amoxiclav 625mg PO 8 hourly
Alternative - Co-trimoxazole 960mg PO 12 hourly or Ciprofloxacin 500mg PO 12 hourly (consider safety issues)