AHAH: Urinary Tract Infections

Consider catheter change under antimicrobial cover.

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

Antibiotic Regimens:

Route	Antibiotic and Dosage	Notes
Oral (Preferred)	nitrofurantoin 50mg po QDS	Or Oxford Health will use nitrofurantoin M/R 100mg BD (not on formulary at OUH). See Nitrofurantoin MHRA drug safety updates
	cefalexin 500mg po BD
	fosfomycin 3g po every 3 days	1 dose in female, 2 doses in males
	co-trimoxazole 960mg po BD	Pause ACE inhibitors/Angiotensin receptor blockers or Potassium sparing diuretics Ideally reserve for more serious infections
	pivmecillinam 400mg po STAT then 200mg po TDS
IV	gentamicin 5mg/kg iv STAT	1 dose is considered curative See gentamicin monograph for dosing (including renal dosing)

Order of preference by eGFR (mL/min/1.73m²):

eGFR 45 or more: Options in the table are in order of preference
eGFR 30 upto 45: cefalexin > fosfomycin > nitrofurantoin (note Nitrofurantoin MHRA drug safety updates) or co-trimoxazole> pivmecillinam
eGFR less than 30: cefalexin >fosfomycin> pivmecillinam

Change catheter (if present) under antimicrobial cover.

Duration: 5-7 days

Antibiotic Regimens:

Route	Antibiotic and Dosage	Notes
Oral (Preferred)	cefalexin 1g po TDS
Oral (Preferred)	co-trimoxazole 960mg po BD	Pause ACE inhibitors/Angiotensin receptor blockers or Potassium sparing diuretics
IV (Aim for rapid oral switch)	gentamicin 5mg/kg iv OD (gentamicin is for a maximum of 3 days).	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

Change catheter (if present) under antimicrobial cover.

Duration: 7 days

Antibiotic Regimens:

NB: Here IV therapy is usually preferred over ciprofloxacin.

Route	Antibiotic and Dosage	Notes
Oral	ciprofloxacin 750mg po BD	See Fluoroquinolone antibiotics - severe adverse effects section for MHRA alert information
IV (Aim for rapid oral switch)	gentamicin 5mg/kg iv STAT	1 dose is considered curative See gentamicin monograph for dosing (including renal dosing)
IV (Aim for rapid oral switch)	piperacillin-tazobactam Elastomeric (13.5g/24h)	Via OPAT

If no regimen is considered suitable, or there is a preference to avoid quinolones, consult the infection team.

Lower UTI (including suspected CA-UTI)