Acute upper urinary tract infection (pyelonephritis/urosepsis) or catheter-associated infection
For moderate illness with systemic upset not requiring hospital admission.
Co-amoxiclav 625mg, 3 times daily
In penicillin allergy (beware of side effect risk, see notes above)
Ciprofloxacin 750mg, twice daily
When sensitivities are known, suitable oral agents include amoxicillin, cefalexin and trimethoprim, in addition to those recommended above.
For severe infection (hospital treated)
Mandatory review of gentamicin following culture and sensitivity information.
Check SCi Store for urinary pathogens isolated in last 6 months not covered by gentamicin or aztreonam and seek advice from Microbiology
IV Gentamicin Refer to NHS Highland gentamicin dosing guidelines
7 to 14 days
In severe renal impairment (CrCl less than 10ml/min) or renal replacement therapy or where gentamicin unsuitable. Review dose if renal function improves.
IV Aztreonam 1 gram stat then 250mg 3 times daily
7 to 14 days
When switching to oral therapy without positive microbiology results
Follow recommendations for moderate illness.
For infections arising within 24 hours of surgery where gentamicin has been given as part of surgical prophylaxis
Substitute IV aztreonam 2g every six hours for gentamicin