Infection

Upper UTI or pyelonephritis without sepsis
Antibiotic Therapy (before prescribing carefully read the Notes / Comments section below)

First line:

Co-trimoxazole oral 960mg 12 hourly 

N.B. Not suitable if known trimethoprim resistance.

Second line:

Ciprofloxacin oral 500mg 12 hourly
Duration

5-7 days
Notes / Comments

Patients presenting with UTI and a history of fever or back / flank pain may have pyelonephritis. Upper UTIs are not infrequently associated with potentially life-threatening bacteraemia. 

  • Send an MSSU for culture and sensitivities before starting empirical antibiotics.
  • Always consider hospital admission for adults with upper UTI / pyelonephritis. Patients who are being managed in the community with acute pyelonephritis should be admitted to hospital if they have failed to respond to antibiotics within 24 hours. 
  • Refer all men to urology who have had symptoms of upper UTI / pyelonephritis. 
  • Consider prostatitis in the differential diagnosis of men with acute dysuria or frequency, and in men with recurrent or febrile UTI. 
  • Nitrofurantoin is an ineffective treatment for upper UTI as it does not achieve effective concentrations in the blood.
  • Ciprofloxacin is a high risk drug for Clostridium difficile infection, but the benefits are considered to outweigh the risks in acute pyelonephritis.

 

 

Guideline reviewed June 2023
Page updated March 2024



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