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​​​​Catheter-Associated UTI

Gentamicin is contraindicated in Myasthenia Gravis. Discuss with medical microbiology for an alternative antibiotic and see this guideline​ for further advice.

Refer to the Sepsis guideline - full version.pdfSepsis guideline - full version.pdf for full investigation and management recommendations in patients with sepsis.​
 
 
First Line
Second line
​Allergy status ​​Confirm allergy status prior to choosing antimicrobial regime ​
Antimicrobial
warning symbol.png 
Check for interactions
  Co-trimoxazole*

AND

Gentamicin STAT if  NEWS 5 or sepsis red flag features​​​
 ​Ciprofloxacin**

AND

Gentamicin STAT if  NEWS 5 or sepsis red flag features​​​

Dose
 Co-trimoxazole* 960mg every 12 hours

AND

Gentamicin
(Dose and frequency according to calculator​– maximum 450mg in 24 hours)
​Ciprofloxacin** 500mg every 12 hours
 
AND

Gentamicin
(Dose and frequency according to calculator​– maximum 450mg in 24 hours)
Route
PO co-trimoxazole
IV gentamicin 
 ​PO ciprofloxacin*
IV gentamicin
Duration
Review at 48-72 hours
​
If patient remains unwell at 24 hours or deteriorating discuss with Medical Microbiology
 
Additional Information 
  • ​*Co-trimoxazole contains trimethoprim - it should not be used in patients with history of trimethoprim allergy or trimethoprim-resistant organisms. Discuss with Medical Microbiology if there is a previous history of resistant gram negative bacteria and/or of recurrent UTIs.
  • *For patients >100kg, discuss co-trimoxazole dosing with pharmacy.
  • Refer to interactions page or ward pharmacist for co-trimoxazole interactions.
  • **Ciprofloxacin can lower the seizure threshold and should be avoided in those with a history of seizures.

  • ​If you are treating a catheter-associated UTI please note;

-        Ward test urine (WTU)/dipstick should not be used to diagnose a UTI  in patients with a catheter, as it will invariably be positive.

-        Document clinical signs and symptoms within pens and send a urine sample for culture and sensitivities. 


 ​IV to PO arrow.png 
 
 
First Line
Second Line
Antimicrobial
  
According to culture and sensitivity results 
 
Dose
Route
Duration
5 days total duration (including IV therapy) 
 
 
**Fluoroquinolone are ineffective if given with multi-valent cation containing products e.g. antacids, supplements or feeds containing calcium, iron, magnesium, zinc, sucralfate or bismuth. These products bind to the antibiotics and reduce their absorption by up to 90%.
 
If patients are prescribed antacids or supplements containing calcium iron, magnesium zinc or bismuth. It is advised these medications are stopped/withheld for the duration of antibiotic treatment. If this is not possible due to a clinical need, then an alternative antibiotic must be considered
If ciprofloxacin and a cation containing product must be prescribed together:
·         Administration times should be as far apart as possible
·         Reduce the dosing frequency of the interacting product if possible
·         In the case of oral nutritional supplements, multiple sips throughout the day should be replaced with set administration times to enable adequate spacing from oral antibiotic administration
·         If a patient is receiving an enteral feed tetracyclines and fluoroquinolones should generally be avoided unless there is a specific feed free window  
 
 
 
 
 
 
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