UTI in Chronic Kidney Disease | Right Decisions

Right Decisions
Antimicrobial prescribing: NHS Forth Valley
Primary Care Guidance
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UTI in Chronic Kidney Disease

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.

UTI in Chronic Kidney Disease

CKD 4/5

Ref: Renal Drug Handbook

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 to allow lab to release sensitivities to cefalexin (ciprofloxacin for penicillin allergic patients)

Drug details

CKD 4: Trimethoprim (with caution)

200mg BD

5 days

or Cefalexin

500mg BD

5 days

or (penicillin allergy)Ciprofloxacin

250mg BD

5 days

CKD 5: Cefalexin

250-500mg BD

5 days

or (penicillin allergy)Ciprofloxacin

250mg BD

5 days

Pivmecillinam and Fosfomycin can be used if sensitivities support

Pivmecillinam (unlikely to be effective in patients with little residual kidney function)

400mg initially then 200mg TDS

5 days

Fosfomycin

If eGFR >10ml/min

3g dose as stat and repeated after 72 hours for men only