Canterbury DHB

Context

Acute Pyelonephritis or Complicated Urinary Tract Infection

Pathogens

Drug Treatment

Empiric

Non-pregnant Patients

gentamicin

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Single dose of IV 5 mg/kg ideal body weight. Round dose to the nearest half vial (40 mg)

AND one of the following three agents (listed in order of preference):

amoxicillin+clavulanic acid

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PO 500 mg/125 mg three times a day

OR

cefalexin

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PO 1000 mg four times a day

OR

ciprofloxacin

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PO 500 mg twice a day

If severe renal failure, i.e. CrCl or eGFR < 20 mL/min

ceftriaxone

HMLSchedNZFPMLnoids

IV 1 g every 24 hours

followed, if sensitive, by

cefalexin

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PO 500 mg twice a day

OR

ciprofloxacin

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PO 250 mg twice a day

Pregnant Patients

ceftriaxone

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IV 2 g every 24 hours

followed, if sensitive, by

cefalexin

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PO 1000 mg four times day

OR, after 14 weeks’ gestation (not in the first trimester - folate antagonist):

trimethoprim+sulfamethoxazole

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PO 160 mg/800 mg twice a day

Pathogens Known

E. coli

If susceptibilities allow:

trimethoprim

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PO 300 mg once a day

Enterococci

amoxicillin

HMLSchedNZFPMLnoids

IV 1 g every eight hours

or PO 500 mg three times a day

Penicillin allergy

Consult Infectious Diseases/Clinical Microbiology

Pseudomonas aeruginosa

gentamicin

HMLSchedNZFPMLnoids

Single dose of IV 5 mg/kg ideal body weight. Round dose to the nearest half vial (40 mg)

followed by

ciprofloxacin

HMLSchedNZFPMLnoids

PO 500 mg twice a day

Extended-spectrum beta-lactamase (ESBL) producing coliforms – consult Infectious Diseases/Clinical Microbiology, inform Infection Prevention, and give:

meropenem

HMLNZFPMLnoids

IV 1 g every eight hours

Information about this Canterbury DHB document (99243):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

February 2019 (Urinary Tract Infections)

Next Review Due:

February 2022

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 99243