"?UTI ?LRTI"

First Line

Therapy

Amoxicillin 500mg PO 8 hourly AND *Nitrofurantoin 100mg MR PO 12 hourly or Trimethoprim 200mg PO 12 hourly

(Check previous cultures and  sensitivities)

*Nitrofurantoin is contra-indicated in patients with an eGFR < 45ml/min however a short course (3-7 days) may be used with caution in patients with an eGFR 30-44ml/min with suspected or proven multidrug resistant pathogens. Toxic plasma concentrations can occur particularly in the elderly causing adverse effects eg neuropathy, blood dyscrasias

 

Penicillin Allergy

Therapy

Doxycyline 200mg STAT, then 100mg PO daily AND *Nitrofurantoin 100mg MR PO 12 hourly or Trimethoprim 200mg PO 12 hourly

(Check previous cultures and  sensitivities)

* Nitrofurantoin is contra-indicated in patients with an eGFR < 45ml/min however a short course (3-7 days) may be used with caution in patients with an eGFR 30-44ml/min with suspected or proven multidrug resistant pathogens. Toxic plasma concentrations can occur particularly in the elderly causing adverse effects eg neuropathy, blood dyscrasias

Notes

In patients who have no features of sepsis, not requiring intravenous antibiotics with possible chest or urine as most likely source then treating with broader spectrum agents e.g co-amoxiclav, ciprofloxacin maybe associated with higher risk of C.diff and toxicity.