7. Urinary Tract

Patients with asymptomatic bacteruria should not be treated with antibiotics, except in pregnancy. This includes patients with catheter-associated bacteruria.

Infection	IV treatment	Oral treatment	Total duration
Uncomplicated lower urinary tract infection in women		Trimethoprim 200mg BD	3 days only except: Symptom for > 1 week Anatomical abnormalities Immunosuppression Neutropenia Catheter-associated infection Impaired renal function No response (antibiotic choice should be reviewed)
Uncomplicated lower urinary tract infection in pregnant women	.	1st choice - amoxicillin 500mg TDS 2nd choice - cefalexin 500mg BD	7 days Perform urine culture 7 days after antibiotic treatment to test for cure
Uncomplicated lower urinary tract infection in men	.	Trimethoprim 200mg BD	7 days
Pyelonephritis	1st choice - gentamicin 3-5mg/kg OD IV (See protocol for dose. Monitor levels) 2nd choice - cefuroxime 1.5g tds IV	Switch to oral based on sensitivities	14 days in total
Prostatitis		1st choice - ciprofloxacin 500mg bd 2nd choice - trimethoprim 200mg bd Check the sensitivity of the isolate.	Review after 28 days.

Amend choice of antibiotic therapy according to reported sensitivities

*For patients with renal impairment refer to section 23 for dosage adjustments

Extended spectrum Beta-lactamase producers (ESBLs)

Sensitivities may report "multi-resistant organism ESBL producer". These organisms (usually E. coli or Klebsiella) produce enzymes that de-activate all penicillins and cephalosporins. They may also be multi-resistant to other antibiotics, therefore they must be treated according to sensitivity patterns. For further advice contact microbiology (ext. 2885).