Medical Treatment: Empirical treatment is indicated only if:
- Positive leucocytes and nitrites on urine test strips, or
- Leucocytes or nitrites with symptoms of UTI, or
- Systemic signs and symptoms.
Alkalinising agents are not advised as many antibiotics require a lower urinary pH.
Uncomplicated cystitis - Ciprofloxacin, oral, 500 mg as single dose.
Complicated cystitis - Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
For pregnant women:
- Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 7 days.
Acute pyelonephritis - Admit all patients with vomiting, sepsis or diabetes.
- Ensure adequate hydration with intravenous fluids.
- If there is a poor response, perform an ultrasound on all hospitalised patients urgently as in-patients or electively as out-patients.
Adjust antibiotic according to sensitivity. Duration of antibiotic therapy:
- fluoroquinolones 7 days.
- other antibiotics 14 days.
Longer courses of therapy, 2-3 weeks, should be given for complicated pyelonephritis.
If normal renal function:
- Gentamicin, IV, 6 mg/kg daily.
Switch to oral therapy as soon as the patient is able to take oral fluids:
- Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
If impaired renal function:
- Ceftriaxone, IV, 1 g daily.
Switch to oral therapy as soon as the patient is able to take oral fluids:
- Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
- CrCl: less than 10 mL/minute 50% of normal dose
Refer to a urologist if there is failure to resolve.
