Empirical Antibiotic Therapy in Suspected Urinary Tract Infection
| Always refer to any local guidelines as resistance rates vary depending on geography, and consider community versus health-care associated infection (HAI). HAIs are commonly more resistant than community acquired UTIs. Examples of standard recommendations are given below. | |
| Simple community-acquired lower urinary tract infection | |
| Trimethoprim 50 mg 6-hourly PO or nitrofurantoin 100 mg 12-hourly PO | |
| Women 3 days | Men 7 days |
| (Nitrofurantoin is not appropriate if upper renal tract or prostatitis is possible as it does not achieve reliable prostatic or renal parenchymal tissue concentrations. Nitrofurantoin is also not appropriate if eGFR is <45 mL/min.) | |
| Simple health-care-associated acquired lower urinary tract infection | |
| Cephalexin 500 mg 8-hourly PO or co-amoxiclav 625 mg 8-hourly PO | |
| Women 3 days | Men 7 days |
| Suspected pyelonephritis | |
Aminoglycoside (e.g. gentamicin 5 mg/kg) IV plus IV co-amoxiclav or Aminoglycoside (e.g. gentamicin 5 mg/kg) IV plus a second-generation cephalosporin IV (e.g. cefuroxime) or Oral quinolone (e.g. ciprofloxacin) if mild pyelonephritis in a patient in whom the likelihood of quinolone resistance is <10% (based on local epidemiology) and there has been no quinolone exposure in the last 3–6 months. Course length 10–14 days. Seven days of ciprofloxacin has shown to be equivalent to 14 days. In all cases, subsequent antibiotic therapy post 48 h should be tailored to an appropriate single agent on receipt of susceptibility data and consider IV to oral switch depending on defervescence and clinical improvement. | |