Antibiotics - Genitourinary

Infection

Uncomplicated UTI

Nitrofurantoin 50mg q6h po
Or
Cefalexin 250mg q6h po or 500mg q12h po.

Review treatment when culture results available

Nitrofurantoin 50 q6h po
Or
if no history of anaphylaxis with penicillin: Cefalexin 250mg q6h po or 500mg q12h po

Review treatment when culture results available.

3 days for women.

7 days for men.

Review treatment with culture results.

Do not use Nitrofurantoin in renal impairment (Creat. clearance <60ml/min).

Ciprofloxacin sensitivity is not generally reported. Contact microbiology to check sensitivity of urine isolate to ciprofloxacin if necessary.

Infection

Complicated UTI (pyelonephritis)

Co-amoxiclav 1.2g q8h iv
plus
Gentamicin 5mg/kg q24h iv (max 480mg), depending on severity.

Risk factors for MDRO:

Contact micro.

Only if documented Hx of ESBL:

Meropenem 1g q8h iv (increase to 2g q8h if confirmed).

Ciprofloxacin 400mg q8-12h iv / 500-750mg q12h po
plus
Gentamicin 5mg/kg q24h iv (max 480mg q24h).

If documented Hx of ESBL/ MDRO:

Check sensitivities. If sensitive & no recent exposure: As above. Otherwise seek advice from microbiology.

Review need for Gentamicin once culture results available and clinical improvement.

Gentamicin course should not usually exceed 7 days.

Ciprofloxacin sensitivity is not generally reported.

Contact microbiology to check sensitivity of urine isolate.

If MUH / SIVUH

Ciprofloxacin 500-750mg q12h po
plus
Gentamicin 5mg/kg q24h iv (max 500mg q24h)

Infection

Urinary tract sepsis

Coliforms, Enterococcus sp.

Co-amoxiclav 1.2g q8h iv
plus
Gentamicin 5mg/kg iv (max 480mg q24h), depending on severity.

Seek daily review of Gentamicin.

Risk factors for MDRO:

Contact micro.

Only if documented Hx of ESBL:

Meropenem 1g q8h iv.

Ciprofloxacin 400mg q8-12h iv
plus
Gentamicin 5mg/kg iv (max 480mg q24h).

If documented history of ESBL/ MDRO:

Check sensitivities. If sensitive & no recent exposure: As above. Otherwise seek advice from micro.

Send urine sample in addition to blood culture.

Previous culture results may help guide therapy.

Seek advice on oral options and duration of therapy

Gentamicin is rarely required for more than 7 days.

Infection

Catheter-related bacteriuria

Usually antibiotics are not indicated.

Only treat if clinical evidence of infection.

Seek advice from microbiology.

Usually antibiotics are not indicated. Only treat if clinical evidence of infection. Seek advice from microbiology.

Infection

Epidydimo-orchitis

Chlamydia trachomatis, N. gonorrhoea, Coliforms

If sexually transmitted infection is the DDx:

Ceftriaxone 500mg im stat
plus
Azithromycin 1g po stat.

If enteric source likely:

Add
Ciprofloxacin 500mg-750mg q12h po

In severe penicillin allergy contact micro. or I.D. for advice.

Please ask ID/micro for advice.

Treatment should be reviewed with culture results.

Consider TB as a diagnosis.

Infection

Pelvic inflammatory disease

Ceftriaxone 500mg stat im
plus
Metronidazole 400mg q12h po
plus
Doxycycline 200mg stat then 100mg q12h po.

Severe PID:

Ceftriaxone 2g q24h iv (until 24 hours after clinical improvement)
plus
Metronidazole 400mg q12h po
plus
Doxycycline 100mg q12h po for 14 days.

In severe penicillin allergy contact microbiology or I.D. for advice.

Take blood cultures and endocervical swab for culture and Chlamydia investigation.

Send serum for VDRL/RPR.

If surgical drainage required, send pus for culture.

Infection

Vaginal candidiasis

Clotrimazole pessary 500mg pv stat.

Add Clotrimazole 2% cream if vulvitis present.

Add Fluconazole 150mg po stat if severe or not responding to clotrimazole pessary.

For recurrent vulvovaginal candidiasis:

Initially Fluconazole 150mg po every 72hours for 3 doses, then 150mg po once weekly for 6 months.

As above.

Consider bacterial vaginosis if not responding and malodorous discharge.