Lower UTI in CKD or 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:

Severe Infection with CKD4, CKD5 or AKI

Therapy

Ceftriaxone 2g IV 24 hourly

 or

Ciprofloxacin 500mg PO 12 hourly (consider safety issues and review if alternative option from urine culture asap if prescribed)

Notes:

Notes

Treatment duration:

Female UTI - 3 days

Male UTI - 7 days 

 

  • 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 release sensitivities to other agents such as cefalexin, pivmecillinam, fosfomycin

 

Alternative options for CKD4 or 5:

Pivmecillinam (if sensitivities support)  - unlikely to be effective in patients with little residual kidney function

400mg STAT, then 200mg 8 hourly PO (to a total course of 10 tablets)

 

 

Reference - Renal Drug Database.

To get access to the Renal Drug Database - email knowledge@nes.scot.nhs.uk for login details.