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​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Pyelonephritis/Urinary Sepsis 
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.

Causative organisms: Escherischa coli (responsible for 75-90% of UTIs), Klebsiella, Pseudomonas and Staphlococcus sapropyticus
Please see table below if the oral route is viable first line.
First Line
Second line
Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)
No penicillin allergy

​Penicillin allergy
warning symbol.png 
Check for interactions
Gentamicin STAT if  NEWS 5 or sepsis red flag features​​​​


​Gentamicin STAT 



Gentamicin 5mg/kg STAT
(Dose and frequency according to calculator – maximum 450mg in 24 hours)


Temocillin* 2g every 8 hours
Gentamicin 5mg/kg STAT
(Dose and frequency according to calculator - maximum 450mg in 24 hours) 


Co-trimoxazole** 960mg every 12 hours
IV gentamicin

IV temocillin*

IV gentamicin

IV/PO co-trimoxazole**

Review at 48 - 72 hours​
If patient remains unwell at 24 hours or deteriorating discuss with Medical Microbiology
Additional Information 
  • *Temocillin: dose adjustment required in renal impairment. Consult ward pharmacist or renal impairment guide​ for further advice.
  • **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 recurrent UTIs.
  • **For patients >100kg, discuss co-trimoxazole dosing with pharmacy.
  • Co-trimoxazole has good bioavailability.
  • Refer to interactions page or ward pharmacist for co-trimoxazole interactions.
  • It is not necessary to check post-dose gentamicin levels if a second dose is unlikely to be required.
  • In people aged 16 years and over with acute pyelonephritis, obtain an MSU before antibiotics are given and send for culture and susceptibility testing. 
IV to PO arrow.png 
First Line
Second Line
​​Allergy status
(Confirm allergy status prior to choosing antimicrobial regime)

No penicillin allergy

Penicillin allergy​
 400mg stat, 200mg every 8 hours
​960mg every 12 hours
​ ​ ​7 days (total therapy including IV)