URO 1.2 UTI with systemic symptoms

Recommendations

≥ 18 years

Indications: in men
	Dosage	Remarks
	cefuroxime IV 1500 mg 3 times daily 14 days	Empirical treatment with ciprofloxacin PO can be considered if hospitalisation is not required or in case of anaphylaxis to beta-lactams For (suspected) acute prostatitis prefer treatment with ciprofloxacin or cotrimoxazole
		For sepsis see URO 1.1 Urosepsis \| Radboud UMC (antibiotica.app)

≥ 18 years

Indications: in women
	Dosage	Remarks
	cefuroxime IV 1500 mg 3 times daily 10 days	When switching to oral agents guided by cultures: beta-lactam or cotrimoxazole: 10 days; ciprofloxacin: 7 days If a shorter treatment is desired (e.g. adverse effects, interactions) a 7-day course may be considered, provided clinical condition is good and no fever >48 h
		For sepsis see URO 1.1 Urosepsis \| Radboud UMC (antibiotica.app)

≥ 18 years

Indications: pregnant women
	Dosage	Remarks
	cefuroxime IV 1500 mg 3 times daily 10 days	When group B streptococcus is cultured there is an indication for antibiotic prophylaxis around delivery; consult the gynaecologist. Treatment duration 10–14 days

≥ 18 years

Indications: if catheter in situ
	Dosage	Remarks
		If catheter <10 days in place follow the recommendations for patients without a catheter
	cefuroxime IV 1500 mg 3 times daily amikacin 20 mg/kg single dose	If catheter >10 days in place or possibly amoxicillin/clavulanic acid + amikacin

≥ 18 years

Indications: patient with diabetes
	Dosage	Remarks
		As per recommendations for patients without diabetes

≥ 18 years

Indications: patients with kidney transplant
	Dosage	Remarks
		Consult the nephrologist >3 months after transplant: as per recommendations for patients without a kidney transplant
		Consult the nephrologist <3 months after transplant: consider coverage for enterococci and Pseudomonas (amoxicillin 1 g, 4 times daily + ceftazidime 2 g, 3 times daily OR ciprofloxacin 400 mg, twice daily; note: adjust dosages to renal function)

≥ 18 years

Indications: patients with renal cysts
	Dosage	Remarks
		In suspected infected renal cyst: obtain cultures, preferably ciprofloxacin 400 mg twice daily IV or 500 mg twice daily PO for 4–6 weeks Drainage is indicated for cysts > 5 cm. See algorithm Swab guideline page 71

Always obtain a urine culture. Adjust antibiotics according to culture results whenever possible.

Review urine cultures from the past year to consider adjusting empirical therapy.

If susceptibility is demonstrated and treatment is completed with ciprofloxacin a total treatment duration of 7 days may suffice.

Replace catheter during treatment if possible. For NSK or JJ catheter always consult the urologist.

Empirical treatment with quinolones is discouraged on the urology ward or if quinolones have been used in the preceding 6 months

Empirical treatment with amoxicillin, amoxicillin/clavulanic acid, cotrimoxazole and trimethoprim is discouraged

In case of (suspected) allergy to penicillins and/or cephalosporins:

Consult the clinical microbiologist/infectious diseases physician for an alternative regimen.