Urinary Tract Infection / Pyelonephritis (Post-operative)

• Asymptomatic bacteriuria does not usually require treatment and in the presence of an indwelling catheter (common) does not indicate infection.
• If symptomatic, see Uncomplicated Acute Lower Urinary Tract Infections (Cystitis) in Women or Acute Pyelonephritis or Complicated Urinary Tract Infection guideline.
• Urosepsis following urological procedure commonly presents with rigors and fever.

Urosepsis

Review culture and susceptibility results as soon as available, aiming to change to directed therapy on day 2. Do not use nitrofurantoin even if proven susceptibility in the laboratory as concentrations are too low to treat an infection outside of the bladder.

CrCl ≥ 20 mL/min

gentamicin HMLSchedNZFPMLnoids Gentamicin F: n/a Half life: 3 hours Elimination: renal fe: 0.9 Additional points: TDM.

IV 5 mg/kg ideal body weight once daily (every 24 hours). Round dose down to nearest half vial (40 mg).

• Therapeutic drug monitoring should be done off the first or second dose (see dosing/monitoring guidelines) if expecting to give more than two doses. Consult with ward pharmacist. Do not give more than three doses (72 hours) except on Infectious Diseases/Microbiology advice.
• fe = 0.9

AND

amoxicillin HMLSchedNZFPMLnoids Amoxicillin F: 0.9 Half life: 2 hours Elimination: renal fe: 0.9

IV 2 g every eight hours

• fe = 0.9, consider adjusting dose if CrCl reduced.

Penicillin allergy

AND

vancomycin HMLSchedNZFPMLnoids Vancomycin F: n/a Half life: 6 hours Elimination: renal fe: 0.9 Additional points: TDM

See dosing guidelines.

• fe = 0.9, adjust dose if CrCl reduced.
• Must be given diluted (1 g in at least 200 mL) and slowly (≤ 1000 mg/hour) to minimise infusion reactions.

Renal failure (CrCl < 20 mL/min)

ceftriaxone HMLSchedNZFPMLnoids Ceftriaxone F: n/a Half life: 8 hours Elimination: 50% renal and 50% biliary excretion fe: 0.5

IV 2 g once daily (every 24 hours)

• fe = 0.5

Previous infection with an extended spectrum beta-lactamase (ESBL)-producing organism

meropenem HMLNZFPMLnoids Meropenem F: n/a Half life: 1 hour Elimination: renal; hydrolysis fe: 0.7

IV 1 g every eight hours

• Meropenem rapidly and significantly reduces sodium valproate concentrations. Concomitant administration may precipitate seizures in patients with a pre-existing seizure disorder. Discuss alternative antibiotic options with Infectious Diseases/Clinical Microbiology.
• If still on meropenem beyond 48 hours, consider measuring a trough concentration. Consult Infectious Diseases for interpretation.
• fe = 0.7, start with full dose initially then consider extending dose interval and/or decreasing dose for subsequent doses if CrCl is reduced (< 30 mL/min). Consult pharmacist.
• Ertapenem IV 1 g once daily (every 24 hours) may be used at discharge if susceptibility is proven.

Topic Code: 99287

must be prescribed or recommended by a consultant.