Antimicrobial prescribing: NHS Lothian
- Blood cultures
- Urine culture
- If source control/ urinary stent inserted, send appropriate sample(s) for microbiology culture in white top universal container(s).
Complicated pyelonephritis related to urinary tract obstruction
Warning
Urgent urology review is required, with renal tract imaging and source control where appropriate.
Review any recent microbiology samples, including review of last three cultures (up to 12 months ago). If gentamicin resistant organism isolated, please contact microbiology.
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Recommended Antibiotic
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Amoxicillin 1g every 8 hours IV AND Gentamicin (use NHS Lothian Calculator on AMT intranet page) |
| Penicillin allergy/MRSA |
Vancomycin IV (use NHS Lothian Calculator on AMT intranet page: aim trough levels 15-20mg/L AND Gentamicin (use NHS Lothian Calculator on AMT intranet page) |
Recommended total duration IV and oral: 5 days post source control or 7 days total (whichever is longer). Longer courses (e.g. up to 14 days) may be required for complex patients (including immunocompromised patients) or infection not amenable to drainage. Please discuss with urology and microbiology.
- Review the need for IV antibiotics daily and IVOS when able.
- Review microbiology results. Where a urine or blood culture result is positive choose an antibiotic to which the isolate is sensitive preferentially from the Access group of antibiotics (e.g. amoxicillin, usual dose is 1g every 8 hours, or co-trimoxazole as per dosing below).
- Nitrofurantoin and Pivmecillinam are not suitable for IV oral step down for systemic infections. Cefalexin should only be used for IVOST after discussion with an infection specialist.
If no positive microbiology results available:
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Recommended Antibiotic (including for penicillin allergy)
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Co-trimoxazole 960mg every 12 hours orally. In patients with renal impairment please adjust dose as per BNF and monitor U+Es. Not suitable if patient allergic to trimethoprim, or urine cultures in previous 12 months have shown a trimethoprim-resistant organism. If resistance or alternative agent required contact microbiology for advice. |