Each week we will aim to bring out a concise email that provides 4-5 key pieces of information addressing a specific issue in clinical therapeutics.
This week: Recurrent UTIs – Treatment
Lisa Austin, Clinical Pharmacist, Ward MM
Treatment for recurrent UTIs is different to treating a simple UTI as can be seen below. If the UTI recurs it is necessary to treat for a longer time frame to increase the chance of the treatment being successful. The choice of antibiotic will be dependant on the drug sensitives from the urine sample.
For acute uncomplicated cystitis/ reinfections:
1: Trimethoprim 300mg daily – 3 days non-pregnant women, 7 days men
2: Cephalexin 500mg twice a day – 5 days non-pregnant women, 7 days men
3: Amoxycillin/clavulanate 500/125mg twice a day – 5 days non-pregnant women, 7 days men
4: Nitrofurantoin 100mg twice a day – 5 days non-pregnant women, 7 days men
Treat relapsed UTI as for pyelonephritis and investigate for a functional or anatomical abnormality of the urinary tract.
Empirical therapy for mild pyelonephritis/ relapse or reinfections:
Amoxycillin/clavulanate 875/125mg twice a day – 10 to 14 days or
Cephalexin 500mg four times a day ( 6 hourly) – 10 to 14 days or
Trimethoprim 300mg daily for 10 – 14 days or
Ciprofloxacin 500mg twice a day or norfloxacin 400mg twice a day – 7 days (if pseudomonas aeruginosa)
Consider prophylaxis in patients with frequent reinfections.
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