Lower UTI in CKD or AKI

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

CKD 4

Therapy

Trimethoprim (with caution) 200mg PO 12 hourly

or

Cefalexin 500mg PO 12 hourly

 or

Ciprofloxacin 250mg PO 12 hourly (consider safety issues)

Notes:

CKD 5

Therapy

Cefalexin 250mg PO 12 hourly

 or

Ciprofloxacin 250mg PO 12 hourly

Notes:

Severe Infection with CKD4, CKD5 or AKI

Therapy

Ceftriaxone 2g IV 24 hourly

 or

Ciprofloxacin 500mg PO/IV 12 hourly (consider safety issues and review if alternative option from urine culture asap if prescribed)

Notes:

Notes

Treatment duration:

Female UTI - 3 days

Male UTI - 7 days 

 

  • Avoid nitrofurantoin in patients with CKD 4 or 5.
  • Trimethoprim can be used in patients with CKD 3 (unless baseline K is high). Trimethoprim can cause a temporary increase in serum potassium and creatinine during treatment.
  • Ensure samples are marked with CKD 4 or 5 (or AKI) to allow lab to release sensitivities to other agents such as cefalexin, pivmecillinam, fosfomycin

 

Alternative options for CKD4 or 5:

Pivmecillinam (if sensitivities support)  - unlikely to be effective in patients with little residual kidney function

400mg STAT, then 200mg 8 hourly PO (to a total course of 10 tablets)

 

Fosfomycin

If eGFR>10ml/min - 3g stat for female UTI (repeat 3g dose after 72 hours for male UTI)

 

Reference - Renal Drug Database.

To get access to the Renal Drug Database - email knowledge@nes.scot.nhs.uk for login details.