Upper Urinary Tract Infection or Pyelonephritis in Primary Care

Publication: 30/09/2010  
Last review: 29/05/2014  
Next review: 31/01/2019  
Clinical Guideline
UNDER REVIEW 
ID: 2238 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2014  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system. This includes a recommendation not to use them for mild or moderately severe infections unless other antibiotics cannot be used (MHRA advice November 2018).

Upper Urinary Tract Infection or Pyelonephritis in Primary Care

Upper Urinary Tract Infection (UUTI) is diagnosed clinically
Symptoms of Upper UTI include Dysuria/Frequency AND Fever/Rigors/Loin or Flank Pain (see Upper UTI Guideline)
Send sample on all patients before commencing treatment.
Antibiotic choice should be reviewed with culture and sensitivity results.
Refer to Secondary Care if unwell or if no clinical improvement in first 24 hours of antibiotics

 Empiric Options

Targeted Options (when culture results are available)

Ciprofloxacin electronic Medicines Compendium information on Ciprofloxacin500mg 12-hourly
OR
Co-Amoxiclav (Amoxicillin-Clavulanate) electronic Medicines Compendium information on Co-Amoxiclav (Amoxicillin-Clavulanate)625mg 8-hourly

Ciprofloxacin electronic Medicines Compendium information on Ciprofloxacin500mg 12-hourly for 7 days (or 14 days if renal tract abnormality)
Trimethoprim 200mg (or Co-trimoxazole electronic Medicines Compendium information on Co-trimoxazole960mg) 12-hourly for 14 days
Co-Amoxiclav (Amoxicillin-Clavulanate) electronic Medicines Compendium information on Co-Amoxiclav (Amoxicillin-Clavulanate)625mg 8-hourly for 14 days
Cefalexin electronic Medicines Compendium information on Cefalexin500mg 8-hourly for 14 days
Amoxicillin electronic Medicines Compendium information on Amoxicillin500mg 8-hourly for 14 days
(durations include initial empiric antibiotic treatment before culture results available)

Notes

Co-amoxiclav electronic Medicines Compendium information on Co-amoxiclav contains penicillin and should be avoided in patients with penicillin allergy
Avoid Ciprofloxacin in pregnancy
Avoid Nitrofurantoin Does not achieve sufficient concentration in kidneys
Avoid Pivmecillinam electronic Medicines Compendium information on Pivmecillinam No evidence to support efficacy in Upper UTI

HPA, QRG, SIGN88, CKS, CKS 

Provenance

Record: 2238
Objective:
  • to provide a simple, empirical approach to the treatment of common infections
  • to promote the safe, effective and economic use of antibiotics
  • to minimise the emergence of bacterial resistance and reduce the incidence of Healthcare Associated Infections in the community
Clinical condition:

Upper Urinary Tract (Acute pyelonephritis) in Adults

Target patient group: Adults
Target professional group(s): Primary Care Doctors
Pharmacists
Adapted from:

Evidence base

Not supplied

Document history

LHP version 1.0

Related information

Not supplied