UTI, lower treatment according to susceptibility tests
Once results are available from urine culture, antibiotics can be tailored according to identified organism and its susceptibility tests.
Treatment of multiple drug-resistant isolates should be discussed with Micro ID.
This guideline is NOT intended for pregnant patients. See UTI, lower, non-severe (pregnant)
Treatment duration: 3 days for women, 3-7 days for men
First Line
trimethoprim 200mg po bd - if susceptible; usually 3 days
Alternative
If resistant to trimethoprim: nitrofurantoin 50mg po qds (caution: do not use if eGFR is under 45 ml/min/1.73m2). Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
If resistant to nitrofurantoin or eGFR under 45ml/min/1.73m2: amoxicillin 500 mg po tds
If resistant to amoxicillin: cefalexin 500mg po bd
If resistant to cefalexin: pivmecillinam 400mg po STAT then 200mg po tds
If resistant to pivmecillinam: fosfomycin 3g po once only
Important Notes
trimethoprim should not be given to patients taking methotrexate
nitrofurantoin is only recommended when eGFR exceeds 45ml/min/1.73m2. Adverse effects have been reported with nitrofurantoin see Nitrofurantoin MHRA drug safety updates
pivmecillinam and amoxicillin are penicillin-based antibiotics and should not be used where there is a history of penicillin allergy
pivmecillinam should not be given to patients taking valproate or methotrexate
fosfomycin is a single 3g oral sachet which lasts 3 days