Urinary Tract Infection

Important: Therapy

Trimethoprim oral 200mg 12 hourly (3 days)

or

Nitrofurantoin oral 50mg 6 hourly or 100mg MR 12 hourly (3 days)

Notes:

Important: Therapy

Trimethoprim oral 200mg 12 hourly (7 days)

or

Nitrofurantoin oral 50mg 6 hourly or 100mg MR 12 hourly (7 days)

Notes:

Important: Therapy

Cefalexin oral 250mg  6 hourly (7 days)

Mid-stream urine sample must be taken.  Always treat asymptomatic bacteriuria.

A post-treatment specimen should always be sent.

Notes:

Important: Therapy

Initial treatment

Amoxicillin 1g IV 8 hourly

Plus

Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.

Second line

Ciprofloxacin oral 500mg 12 hourly. Consider giving initial dose as 400mg IV.

Adjust therapy on basis of culture results or discuss with microbiology.

Total duration (IV&oral) =  7 days then review

Notes:

Important: Therapy

Catheter specimens

In catheterised patients, the bladder quickly becomes colonised.  Microscopy and/or “dip-stick” testing is unhelpful as WBC, rbc, nitrate and protein may all be positive when the bladder is colonised.

Catheter urine samples should be sent for culture and sensitivities only if patient is febrile or systemically unwell and bladder is the likely source.

If possible, remove catheter. Treat only if systematically unwell. If treating, the catheter should be changed.

Initial treatment of CAUTI

Amoxicillin 1g IV 8 hourly

Plus

Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.

Second line

Vancomycin IV (Dosing as per guideline. Use vancomycin calculator.

Plus

Gentamicin IV (Extended Interval Dosing as per guideline) Use Gentamicin Calculator. Max 3 days then review.

Adjust therapy on basis of culture results or discuss with microbiology.

Total duration (IV&oral) =  7 days then review

Use of Antibiotics when changing a long term urinary catheter

• Where patients have previously developed sepsis related to changing a long-term urinary catheter, prophylaxis may be considered.
•  Previously documented antimicrobial resistance should be considered when choosing an appropriate antimicrobial.
• The following suggestions are made for empirical use in the absence of antimicrobial resistance information.

First choice

Gentamicin

Dose: 3 mg/kg (lean body weight) up to a maximum of 320 mg IV single dose

or

Second choice

Trimethoprim

Dose: 200mg orally single dose

Notes:

Important: Therapy

First line: Ciprofloxacin oral 500mg 12 hourly (4-6 weeks)

or

Second line: Trimethoprim oral 200mg 12 hourly (4-6 weeks)

Acute Prostatitis requires immediate treatment.

Chronic Prostatitis requires investigation before antimicrobials are started; only 10% of cases are caused by infection

Notes: