UTI & Pyelonephritis Management

Question 1

LUTI management in non-pregnant women?

Answer 1

1st line: nitrofurantoin 100mg or trimethoprim 200mg 3 days

2nd Line:
Pivmecilinam 400mg initial dose, then 200mg tds 3/7
Fosfomycin 3g single dose sachet

Question 2

Management of recurring LUTI in non-pregnant women?

Answer 2

Trimethoprim or nitro single dose when exposed to a trigger

2nd line: amxocillin or cefalexin single dose when exposed to trigger

Trial dialy abx prophylaxis:
Trimethorpim 100mg
Amoxicillin 250mg or cefalexin 125mg

Question 3

Management of LUTI in pregnant women?

Answer 3

1st Line: nitrofuratoin (avoid at term) 100mg bd 7/7

2nd Line: Amoxicillin or cefalexin for 7 days

Question 4

Management of LUTI in men?

Answer 4

1st line is empirical abx for 7 days:
Trimethoprim 200mg bd OR
Nitrofurantoin 100mg bd

Question 5

Management of recurrent LUTI’s in men?

Answer 5

1st: Single dose when exposed to trigger or prohylaxis at night
Trimethoprim 200mg or nitrofurantoin 100mg

2nd Line: amoxicillin or cefalexin

Question 6

Management for acute pyelonephritis in non-pregnant women, men, and people with indwelling catheters?

Answer 6

1st Line:
Cefalexin 500mg bd 7-10days

OR

Co-amoxiclav, trimethoprim (14 days), ciprofloxacin

Question 7

Management for acute pyelonephritis in pregnant women who do not require admission?

Answer 7

Cefalexin 500mg up to tds for 7-10 days.

Question 8

Features of pyelonephritis?

Answer 8

Fever/rigors
Malaise
Loin/flank pain
Vomiting

Question 9

Investigations for ?pyelonephritis?

Answer 9

Urine dip: +leucocytes and nitrites
Bloods: raised WCC, U&E, blood cultures
Urine MSU and MC&S
Renal USS or CT scan to exclude other pathologies

Question 10

Management of pyelonephritis for patients who require hospital admission?

Answer 10

Sepsis 6:
Get lactate, blood cultures and urine output
Give O2, empirical broad spec abx (cephalosporin, gentamicin), IV fluids