Lower UTI in Chronic Kidney Disease (or in AKI)


Trimethoprim (with caution) 200mg PO 12 hourly


Cefalexin 500mg PO 12 hourly



Ciprofloxacin 250mg PO 12 hourly (consider safety issues)


Cefalexin 250mg PO 12 hourly


Penicillin allergy:

Ciprofloxacin 250mg PO 12 hourly


  • 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

Alternative options for CKD4 or 5:

Pivmecillinam (if sensitivities support)  - unlikely to be effective in patients with little residual kidney function

400mg STAT, then 200mg 8 hourly PO (to a total course of 10 tablets)



If eGFR>10ml/min - 3g stat for female UTI (repeat 3g dose after 72 hours for male UTI)


Treatment duration:

Female UTI - 3 days

Male UTI - 7 days 


Reference - Renal Drug Database

To get access to Renal Drug Database - email Ann.lees@nes.scot.nhs.uk for user name and password