UTIs

Question 1

Uncomplicated UTIs in non pregnant females

Answer 1

Oral first line:
Nitrofurantoin, or trimethoprim (if low risk of resistance).
Oral second line (if no improvement after at least 48 hours, or first line not suitable):
Nitrofurantoin (if not used first line), fosfomycin, pivmecillinam hydrochloride, or amoxicillin (high rate of resistance, so only use if culture susceptible).

Question 2

uncomplicated uti in Males

Answer 2

Oral first line:
Nitrofurantoin, or trimethoprim.
Oral second line (if no improvement after at least 48 hours, or first line not suitable):
Consider pyelonephritis or prostatitis. See pyelonephritis, acute, or prostatitis, acute below for guidance.

Question 3

uncomplicated utis in Pregnant females

Answer 3

Oral first line:
Nitrofurantoin.
Oral second line (if no improvement after at least 48 hours, or first line not suitable):
Amoxicillin (only if culture susceptible), or cefalexin.
Alternative second line:
Consult local microbiologist.
Asymptomatic bacteriuria:
Amoxicillin, cefalexin, or nitrofurantoin.

Question 4

Prostatitis

Answer 4

Oral first line:
Ciprofloxacin, or ofloxacin.
Alternative first line if a fluoroquinolone is not appropriate (seek specialist advice): trimethoprim.
Oral second line (on specialist advice):
Levofloxacin, or co-trimoxazole.
Intravenous first line (if severely unwell or unable to take oral treatment). Antibacterials may be combined if concerned about sepsis.
Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin, or levofloxacin.
Intravenous second line:
Consult local microbiologist.

Question 5

Pyelonephritis, males and non pregnant females

Answer 5

Oral first line:
Cefalexin. If sensitivity known: co-amoxiclav, or trimethoprim. If other first line antibacterials are inappropriate, ciprofloxacin may be used.
Intravenous first line (if severely unwell or unable to take oral treatment). Antibacterials may be combined if concerned about susceptibility or sepsis.
Amikacin, ceftriaxone, cefuroxime, or gentamicin. Co-amoxiclav may be used if given in combination or sensitivity known. If other first line antibacterials are inappropriate, ciprofloxacin may be used.
Intravenous second line:
Consult local microbiologist.

Question 6

Pyelonephritis in pregnant females

Answer 6

Oral first line:
Cefalexin.
Intravenous first line (if severely unwell or unable to take oral treatment):
Cefuroxime.
Second line or combining antibacterials if concerned about susceptibility or sepsis:
Consult local microbiologist.

Question 7

Recurrent UTIs

Answer 7

Oral first line:
Trimethoprim, or nitrofurantoin.
Oral second line:
Amoxicillin [unlicensed indication], or cefalexin

Question 8

Catheter associated UTIs in males and non pregnant females

Answer 8

Oral first line (if no upper UTI symptoms):
Amoxicillin (only if culture susceptible), nitrofurantoin, or trimethoprim (if low risk of resistance).
Oral second line (if no upper UTI symptoms and first-line not suitable):
Pivmecillinam hydrochloride.
Oral first line (upper UTI symptoms):
Cefalexin, co-amoxiclav (if culture susceptible), or trimethoprim (if culture susceptible). If other first line antibacterials are inappropriate, ciprofloxacin may be used.
Intravenous first line (if severely unwell or unable to take oral treatment). Antibacterials may be combined if concerned about susceptibility or sepsis.
Amikacin, ceftriaxone, cefuroxime, gentamicin, or co-amoxiclav (only in combination, unless culture results confirm susceptibility). If other first line antibacterials are inappropriate, ciprofloxacin may be used.
Intravenous second line:
Consult local microbiologist.

Question 9

Catheter associated UTIs in pregnant females

Answer 9

Oral first line:
Cefalexin.
Intravenous first line (if severely unwell or unable to take oral treatment):
Cefuroxime.
Second line or combining if concerned about susceptibility or sepsis:
Consult local microbiologist.