UTI in Chronic Kidney Disease 4 or 5
Antimicrobial prescribing: NHS Forth Valley
Ref: Renal Drug Database - please note some doses below are off license
To get access to the Renal Drug Database - email knowledge@nes.scot.nhs.uk to request an individual login.
- Nitrofurantoin should be avoided in patients with CKD 4 or 5 i.e. if eGFR<30 as won't achieve therapeutic concentrations in bladder urine.
- Trimethoprim can cause a temporary increase in serum potassium and creatinine during treatment. Avoid in patients with higher baseline potassium.
Ensure urine culture samples mention CKD 4 or 5 in clinical details so lab are aware when authorising sensitivity testing results.
Drug details
CKD 4
Trimethoprim (with caution)
200mg BD
5 days
or Cefalexin
500mg BD
5 days
or Fosfomycin
3g
Female single dose
Male two doses 72hr apart
CKD 5
Cefalexin
500mg OD
5 days
or Fosfomycin
Only if eGFR >10ml/min
3g
Female single dose
Male two doses 3 days apart
or Pivmecillinam
(unlikely to be effective in patients with little residual kidney function)
400mg initially then 200mg TDS
5 days