Ambulatory care: Urinary tract infection

Duration: Treat for 3 days (female), 7 days (male or catheterised)

Antibiotics:

Preferred:

• nitrofurantoin 50mg po qds (caution: avoid if eGFR less than 45 ml/min/1.73m²).
• Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates

Alternative:

• cefalexin 500mg po bd
• Or gentamicin 5mg/kg iv ONCE ONLY. If creatinine clearance less than 30 ml/min reduce dose to 3mg/kg
• Or trimethoprim 200mg po bd (only when susceptibility results are known and trimethoprim sensitive)
• Or pivmecillinam 400mg po STAT then 200mg tds
• Or fosfomycin 3g po every 72 hours (max 2 doses)

Duration: Treat for 7 days

Take urine sample prior to starting antibiotics

Preferred:

• co-trimoxazole 960mg po bd

Alternative:

• cefalexin 1g po tds
• Or trimethoprim 200mg po bd (only when susceptibility results are known and trimethoprim sensitive)
• Or gentamicin: initially 5 mg/kg iv for 3 days then tailor to culture results. Take a gentamicin level at 6-14 hours after first dose to calculate dosing interval, usually 24 hourly, 36 hourly or 48 hourly. See gentamicin monograph for dosing (including renal dosing) and monitoring.