Lower UTI in CKD or AKI | Right Decisions

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Antimicrobial prescribing: NHS Forth Valley
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Urinary Tract Infection
Lower UTI in CKD or AKI

Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits.

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number. To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

CKD 4

Important: 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

Important: 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

Important: 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:

Important: 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.