UTI in Chronic Kidney Disease

UTI in Chronic Kidney Disease

CKD 4/5

 

Ref: Renal Drug Handbook

  • 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 to allow lab to release sensitivities to cefalexin (ciprofloxacin for penicillin allergic patients)

CKD 4: Trimethoprim (with caution) 

200mg BD

5 Days

or  Cefalexin

500mg BD

5 Days

or (penicillin allergy) Ciprofloxacin

250mg BD

5 Days

CKD 5: Cefalexin

250-500mg BD

5 Days

or (penicillin allergy) Ciprofloxacin

250mg BD

5 Days

Pivmecillinam and Fosfomycin can be used if sensitivities support

Pivmecillinam (unlikely to be effective in patients with little residual kidney function)

400mg initially then 200mg TDS

5 Days

Fosfomycin

If eGFR >10ml/min

3g dose as stat and repeated after 72 hours for men only