Recurrent/Catheter UTI

Question 1

Background

Answer 1

RECURRENT
Get specialist advise if cause is unknown for recurrent UTI.

Post menopausal women with recurrent UTI consider vaginal oestrogen at lowest effective dose.
- Review in a year

If put on antibiotic long term get reviewed every 6 months. To see if still needed and if it works.

Catheter UTI
Consider removing or changing catheter ASAP if been in >7 days.
Immediate antibacterial + Urine sample b4 treatment start.

• Can refer if they are also dehydrated or unable to take fluids or meds, are pregnant, higher risk of complications, have recurrent catheter UTI or bacteria resistant to meds.

Question 2

Treatment

Answer 2

Recurrent
Women and men
Oral 1st line:
Trimethoprim, or nitrofurantoin.
Oral 2nd line:
Amoxicillin [unlicensed], or cefalexin.

Catheter UTI
- IV used if severely unwell or unable to take oral treatment

Non pregnant women and men:

Oral 1st line (if no UUTI symptoms):
Amoxicillin (only if culture susceptible), nitrofurantoin, or trimethoprim (if low risk of resistance).

Oral 2nd line (if no UUTI symptoms and 1st-line not suitable):
Pivmecillinam HCl

Oral first line (UUTI symptoms):
Cefalexin, ciprofloxacin, co-amoxiclav (if culture susceptible), or trimethoprim (if culture susceptible).

IV 1st line: Antibacterials may be combined if concerned about susceptibility or sepsis.
- Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin, or co-amoxiclav (only in combination, unless culture results confirm susceptibility).

IV 2nd line:
Consult local microbiologist.

Pregnant women:

Oral 1st line: Cefalexin
IV 1st line: Cefuroxime

2nd line or combo if concerned about susceptibility or sepsis:
Consult local microbiologist