Complicated UTI (including urinary sepsis and pyelonephritis)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

Gentamicin IV (as per online calculator) AND Amoxicillin 1g IV 8 hourly

 

If felt hospital admission is not required and no evidence of previous resistance:

Cefalexin 1.5g PO 8 hourly pending culture results

or

If severe penicillin allergy or resistance confirmed/suspected e.g. recent co-amoxiclav or cefalexin: Ciprofloxacin 500mg PO 12 hourly (consider safety issues)

Notes:

If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Temocillin IV dosed per High Dose Antibiotic Therapy guidance. Ensure dose reviewed and appropriately adjusted for improving/deteriorating renal function.

Penicillin Allergy

Therapy

Gentamicin IV (as per online calculator) AND Vancomycin IV (as per online calculator)

Notes:

If concerns regarding nephrotoxicity e.g. acute kidney injury - replace Gentamicin with Aztreonam IV dosed per Renal Drug Database

Notes

UTI + sepsis

OR

Pyelonephritis +/- sepsis

OR

CAUTI + sepsis in men and women

Advice from Urology/Microbiology :-  Do not routinely change catheters for simple UTIs. Consider catheter change if severe sepsis or infection not resolving on treatment.

Send blood culture and urine and follow up results

Check previous urine results for guidance

 

Treatment duration: 7 days

If poor clinical response: review microbiology results, consider complicated infection (e.g. perinephric abscess, obstruction) seek senior clinical review 

 

 

Oral switch guidance

Review culture results first. If no positive microbiology to guide:

Preferred regime - Co-amoxiclav 625mg PO 8 hourly

Alternative - Co-trimoxazole 960mg PO 12 hourly or Ciprofloxacin 500mg PO 12 hourly (consider safety issues)