Urinary tract infection

NHS Dumfries & Galloway Antimicrobial Handbook
NHS Dumfries and Galloway

Review previous microbiology results: If resistant target organisms previously isolated (e.g. MRSA, ESBL, known resistance to empirical antibiotic choices), discuss antibiotic choice with Paediatric and/or Microbiology Consultant.

User guide: for further advice regarding antimicrobial prescribing good practice, oral switch, penicillin allergy, dosing, and safety considerations: HERE

Known to renal service / previous UTIs: check previous urine culture results for known resistance that may influence empirical treatment.

Upper urinary tract infection / pyelonephritis

Fever >38°C AND <3 months
First line

IV cefTRIAXone#
stat IV gentamicin if severely unwell / sepsis

Oral switch: cefalexin**

Penicillin allergy (severe)

IV gentamicin and discuss with Microbiology if severely unwell / sepsis

Oral switch: ciprofloxacin**

TOTAL duration (IV + PO)
  • 7 - 10 days
Fever >38°C AND >3 months and significant systemic upset
First line

IV cefTRIAXone
stat IV gentamicin if severely unwell / sepsis

Oral switch: cefalexin**

Penicillin allergy (severe)

IV gentamicin and discuss with Microbiology if severely unwell / sepsis

Oral switch: ciprofloxacin**

TOTAL duration (IV + PO)
  • 7 - 10 days
Fever >38°C AND >3 months and mild systemic upset
First line

PO cefalexin

Penicillin allergy (severe)

PO ciprofloxacin

TOTAL duration
  • 7 days
Comments

Previous ESBL / AmpC isolated
These isolates are resistant to ceftriaxone. Consider addition of regular gentamicin (if previously susceptible) and/or discussion with Microbiology

  • ** If a cultured uropathogen is susceptible, amoxicillin or trimethoprim should be used as first line stepdown options, instead of the broader-spectrum empirical agents listed.
  • # Use with caution in neonates. For specific contraindications, refer to User Guide - Important drug safety considerations incl. ceftriaxone.
  • Nitrofurantoin is NOT a suitable treatment option for upper urinary tract infection / pyelonephritis

Lower urinary tract infection / cystitis

Increased frequency / dysuria AND no systemic upset / fever AND nitrite negative

Await urine culture result

Treat as per susceptibilities# 

Nitrite positive OR significant symptoms/concerns reGARDING lower UTI and no fever
First line

PO cefalexin

Avoid empirically if ESBL / AmpC previously isolated

Second line
Penicillin allergy (severe)

PO nitrofurantoin if able to take tablets AND >3 months

If unable to take tablets, use third line

Third line
Penicillin allergy (severe)

PO ciprofloxacin

Avoid empirically if ESBL / AmpC previously isolated

TOTAL duration
  • 3 days
Comments

Previous ESBL / AmpC isolated
These isolates have high levels of resistance to cefalexin (100%), trimethoprim (>70%) and ciprofloxacin (>60%).
Most are susceptible to nitrofurantoin (>95%).
If unable to give nitrofurantoin, discuss with Microbiology.

  • # If the cultured uropathogen is susceptible, amoxicillin or trimethoprim should be used as first line, instead of other broader-spectrum empirical agents. 

Editorial Information

Last reviewed: 20/02/2024

Next review date: 20/02/2026

Author(s): Dr Jon van Aartsen (Consultant Microbiologist), Dr Jed Bamber (Consultant Paediatrician).

Version: v1.1 (minor amendments 14/05/2024)

Approved By: AMT (20.02.2024) and ADTC (28.02.2024)

Reviewer name(s): Dr Jed Bamber (Consultant Paediatrician), AMS Team.