UTI in Chronic Kidney Disease
Antimicrobial prescribing: NHS Forth Valley
UTI in Chronic Kidney Disease
CKD 4/5
Ref: Renal Drug Handbook
- Avoid nitrofurantoin in patients with CKD 4 or 5 as won't concentrate in urine adequately
- Trimethoprim can cause a temporary increase in serum potassium and creatinine during treatment. Avoid in patients with higher baseline potassium.
Ensure samples are marked with CKD 4 or 5 so lab are aware when authorising sensitivity testing results.
Drug details
CKD 4
Trimethoprim (with caution)
200mg BD
5 days
or Cefalexin
500mg BD
5 days
or Fosfomycin
3g stat
Female single dose
Male two doses 3 days apart
CKD 5
Cefalexin
250-500mg BD
5 days
or Fosfomycin
3g stat
Female single dose
Male two doses 3 days apart
Pivmecillinam and Fosfomycin can be used if sensitivities support
Pivmecillinam (unlikely to be effective in patients with little residual kidney function)
400mg initially then 200mg TDS
5 days
Fosfomycin
If eGFR >10ml/min
3g dose as stat and repeated after 72 hours for men only