?UTI ?LRTI

First Line

Amoxicillin 500mg tds PO AND *Nitrofurantoin 100mg MR bd PO or Trimethoprim 200mg bd PO

(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

Doxycyline 200mg stat, then 100mg od PO AND *Nitrofurantoin 100mg MR bd PO or Trimethoprim 200mg bd PO

(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 signs of sepsis, not requiring intravenous antibiotics with possible chest or urine as most likely source then treating with broad spectrum agents e.g co-amoxiclav, ciprofloxacin maybe associated with higher risk of CDI.