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

Temocillin*

​Gentamicin STAT 

AND

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

AND

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

AND

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

IV temocillin*

IV gentamicin

IV/PO co-trimoxazole**
Duration
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​
Antimicrobial
 Pivmecillinam
 ​Co-trimoxazole**
Dose
 400mg stat, 200mg every 8 hours
 ​960mg every 12 hours
Route
 PO
 ​PO
Duration
 ​ ​ ​7 days (total therapy including IV)
 
 

 
 
 
 
 
 
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Antibiotic administration​

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