Lower UTI in Chronic Kidney Disease (or in AKI)

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

CKD 4

Therapy

Trimethoprim (with caution) 200mg PO 12 hourly

or

Cefalexin 500mg PO 12 hourly

or

Fosfomycin 3g stat for female UTI (repeat 3g dose after 72 hours in male UTI)

Notes:

CKD 5

Therapy

Cefalexin 250mg PO 12 hourly

or

If eGFR >10ml/min - Fosfomycin 3g stat for female UTI (repeat 3g dose after 72 hours in male UTI)

 

Notes:

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 report appropriately.

 

Alternative option for CKD4 or 5 if no other options suitable e.g. allergy, resistance:

Ciprofloxacin 250mg PO 12 hourly (consider safety issues)

 

Treatment duration:

Female UTI - 3 days

Male UTI - 7 days 

 

Reference - Renal Drug Database.

To get access to the Renal Drug Database - email knowledge@nes.scot.nhs.uk to request an individual login.