First Line

Important: Therapy

Amoxicillin 500mg PO 8 hourly AND *Nitrofurantoin 100mg MR PO 12 hourly or Trimethoprim 200mg PO 12 hourly

(Check previous cultures and  sensitivities)

*Nitrofurantoin is contra-indicated in patients with an eGFR < 45ml/min however a short course (3-7 days) may be used with caution in patients with an eGFR 30-44ml/min with suspected or proven multidrug resistant pathogens. Toxic plasma concentrations can occur particularly in the elderly causing adverse effects eg neuropathy, blood dyscrasias

 

Notes:

Penicillin Allergy

Important: Therapy

Doxycyline 200mg STAT, then 100mg PO daily AND *Nitrofurantoin 100mg MR PO 12 hourly or Trimethoprim 200mg PO 12 hourly

(Check previous cultures and  sensitivities)

* Nitrofurantoin is contra-indicated in patients with an eGFR < 45ml/min however a short course (3-7 days) may be used with caution in patients with an eGFR 30-44ml/min with suspected or proven multidrug resistant pathogens. Toxic plasma concentrations can occur particularly in the elderly causing adverse effects eg neuropathy, blood dyscrasias

Notes:

Important: Notes

In patients who have no features of sepsis, not requiring intravenous antibiotics with possible chest or urine as most likely source then treating with broader spectrum agents e.g co-amoxiclav, ciprofloxacin maybe associated with higher risk of C.diff and toxicity.