Urinary Tract Infection

Duration

See under infection type

Uncomplicated Female lower UTI (not in pregnancy)

Trimethoprim oral 200mg 12 hourly (3 days)

or

Nitrofurantoin oral 50mg 6 hourly or 100mg MR 12 hourly (3 days)

Uncomplicated Male UTI

Trimethoprim oral 200mg 12 hourly (7 days)

or

Nitrofurantoin oral 50mg 6 hourly or 100mg MR 12 hourly (7 days)

Uncomplicated UTI in pregnancy

Cefalexin oral 250mg  6 hourly (7 days)

Mid-stream urine sample must be taken.  Always treat asymptomatic bacteriuria.

A post-treatment specimen should always be sent.

Complicated UTI/pyelonephritis/urosepsis

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.

 

Catheter-associated UTI (CAUTI)

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
Vancomycin 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. 

Bacterial Prostatitis

First line: Ciprofloxacin oral 500mg 12 hourly (4-6 weeks)

or

Second line: Trimethoprim oral 200mg 12 hourly (4-6 weeks)

Acute Prostatitis requires immediate treatment.

Chronic Prostatitis requires investigation before antimicrobials are started; only 10% of cases are caused by infection

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 with suspected/proven multidrug resistant pathogens when the benefits of nitrofurantoin are considered to outweigh the risks of side effects.