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 Formulary Chapter 5: Infections - Full Chapter
Notes:
The development of this chapter for the George Eliot Formulary is in progress
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05.01.13  Expand sub section  Urinary-tract infections
 note 

Urinary tract infection is more common in women than in men; when it occurs in men there is frequently an underlying abnormality of the renal tract.

Uncomplicated UTI

  • If a patient presents with clinical signs/symptoms of UTI or urosepsis please ensure that an MSU sample is sent for routine microscopy and culture.
  • Please DO NOT treat patients for UTI purely on the basis of a positive urine dip result.
  • Urine dip test is only useful to RULE OUT urinary tract infection.
  • If patient has recurrent UTIs, please discuss that case with Microbiology and DO NOT prescribe prophylactic antibiotics.

UTI in Pregnancy

  • Send MSU for culture
  • Treat for 7 days with an oral antibiotic according to results of sensitivity tests.

Antibiotics that are regarded as suitable for use in pregnancy include: cefalexin and amoxicillin (once sensitivity results are available). Nitrofurantoin; do not use close to term as can cause haemolysis in patients with G6PD deficiency. Foetal erythrocytes have little reduced glutatione and there is a theoretical possibility that haemolysis may occur. Trimethoprim; do not use in first trimester or if the pregnant patient is folate-deficient, has a predisposition to folate-deficiency, or is taking another folate antagonist such as an anti-epileptic of proguanil.

Complicated UTI

  • A complicated UTI is defined as a UTI in the presence of an underlying structural abnormality of the renal tract.
  • Urine cultures should be sent to guide targeted antibiotic therapy in all cases.

Catheter-assiciated UTI

  • Patients with a urinary catheter in-situ may have asymptomatic bacteriuria.
  • Unless patient is symptomatic of catheter-associated UTI or systemically septic please DO NOT institure empiric antibiotic treatment.
  • DO NOT initialte antibiotic treatment based on a positive dipstick result only.
  • Please ensure that:
    • catheters are only inserted for appropriate indications
    • catheters are in-situ for only as long as needed
    • catheter insertion is undertaken with aseptic technique
    • following catheter insertion, a closed drainage system is maintained
    • unobstructed urine flow is maintained
    • hand hygeine and standard IP&C precautions are taken when handling the catheter.

Antimicrobial selection should be based upon the culture results when available
Nitrofurantoin
View adult BNF View SPC online View childrens BNF  Track Changes 		First Choice
  • Available as:
    • Modified release capsules (preference)
    • Tablets/Capsules
    • Oral solution
  • Oral solution is very expensive, please crush and disperse the standard release tablets where possible
  • Avoid if patients creatinine clearance is <45ml/min.
 
   
Trimethoprim
View adult BNF View SPC online View childrens BNF  Track Changes 		Second Choice

See section 5.1.8

 
   
 link Link    NICE CG54: Urinary tract infection in children
 link Link    NICE CG97: Lower urinary tract symptoms in Men
 ....
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Traffic Light Status Information

Status Description

Red SO

 SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

 SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

 SPECIALIST ADVISED – Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

 SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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