Severity(classification)

1st line oral/iv antibiotics

Anaphylactic penicillin allergy
(see explanatory notes)

A 

Minor to moderate infection
i.e. uncomplicated UTI (no fever or flank pain) 

Review doses in renal impairment

TRIMETHOPRIM 200mg po bd 

OR
if allergic to Trimethoprim, then use: 
NITROFURANTOIN 50mg po qds
n.b. Contra-indicated in renal impairment

Duration:
Non pregnant women = 3 days
Men and Pregnant women = 7 days

(Pregnancy: Short-term use of trimethoprim or nitrofurantoin is unlikely to cause foetal problems. Consider avoiding trimethoprim in the 1st trimester and nitrofurantoin at term. Cefradine 500mg po bd is an alternative empirical choice in pregnancy). 

Not Applicable  

B

Moderate to severe infection

Review doses in renal impairment

GENTAMICIN iv (as per local protocol)

OR
if gentamicin is contra-indicated (see GHNHSFT protocol), then use:
Age ≤ 40 yrs
CO-AMOXICLAV 625mg po tds
         IV 1.2g tds ONLY if nil by mouth
Age > 40yrs
TAZOCIN 4.5g iv tds

Duration: Typically 7 days
Pyelonephritis: 10 - 14 days

CIPROFLOXACIN 500mg po bd

Duration: Typically 7 days
Pyelonephritis: 10 - 14 days

C

Severe life threatening infection

Review doses in renal impairment

GENTAMICIN iv (as per local protocol)

OR If failure to respond
OR if previous history of infection
OR colonisation with ESBL producing organism
OR ESBL producing organism on culture
OR if Gentamicin is contra-indicated (see GHNHSFT protocol)

Then use:
MEROPENEM 500mg iv tds

ESBL RISK FACTORS

Age >60yrs with serious underlying medical conditions, recent hospitalisation or broad spectrum antibiotic therapy (especially cephalosporins or quinolones), recurrent UTI, urinary catheterisation, previously isolated ESBL producing organism.

Duration: Typically 7 days
Pyelonephritis: 10 - 14 days

If anaphylactic penicillin allergy and ESBL infection suspected / confirmed then use:
AMIKACIN 15mg/kg iv od (max 1.5g od) see local protocol
Only use if serum creatinine <150micromol/L .
Maintain pre-dose (trough) serum level <5mg/l

OR
If AMIKACIN is contra-indicated (see local policy): Discuss with microbiologist

Duration: Typically 7 days
Pyelonephritis: 10 - 14 days

IV to Oral Switch
(explanatory notes)

Review antibiotic therapy with urine culture results.

Consider switch to Trimethoprim po 200mg bd if possible