Lower UTI in Chronic Kidney Disease (or in AKI)

CKD 4

Trimethoprim (with caution) 200mg PO BD for 5 days

or

Cefalexin 500mg BD  PO for 5 days

 

or

Ciprofloxacin 250mg BD PO for 5 days (penicillin allergy)

CKD 5

Cefalexin 250-500mg BD PO for 5 days

or

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

Fosfomycin

If eGFR>10ml/min - 3g stat and repeat after 72 hours for men

Notes
  • 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

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