Lower UTI in Chronic Kidney Disease (or in AKI)
Trimethoprim (with caution) 200mg PO BD for 5 days
Cefalexin 500mg BD PO for 5 days
Ciprofloxacin 250mg BD PO for 5 days (penicillin allergy)
Cefalexin 250-500mg BD PO for 5 days
Ciprofloxacin 250mg BD PO for days (penicillin allergy)
Pivmecillinam (if sensitivities support) - unlikely to be effective in patients with little residual kidney function
400mg stat dose PO then 200mg TDS PO for 5 days
If eGFR>10ml/min - 3g stat and repeat after 72 hours for men
- Avoid nitrofurantoin in patients with CKD 4 or 5.
- Trimethoprim can be used in patients with CKD 3 (unless baseline K is high). Trimethoprim can cause a temporary increase in serum potassium and creatinine during treatment.
- Ensure samples are marked with CKD 4 or 5 (or AKI) to allow lab to release sensitivities to other agents such as cephalexin, pivmecillinam, fosfomycin
Reference - Renal Drug Database
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