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Does the patient have a penicillin allergy? See below for details on penicillin allergy severity

• No penicillin allergy
• Non-severe immediate or delayed penicillin hypersensitivity
• Severe immediate or delayed penicillin hypersensitivity

History of penicillin allergy or adverse reaction

No penicillin allergy

• This includes non-severe reactions such as nausea and limited diarrhoea
• Such reactions are frequently not replicable or generalizable to the whole class. It is safe to prescribe penicillin class antibiotics (with the patient’s knowledge), and if required, use strategies for symptom control such as metoclopramide

Non-severe immediate or delayed penicillin hypersensitivity

• This includes non-severe reactions such as isolated rash
• There is only a 2-3% chance of cephalosporin allergy in a patient with a previous IgE mediated allergy to penicillin, and probably even less for other types of allergies. In most cases it is safe to administer a cephalosporin to a patient who has had a non-life threatening reaction to penicillin

Severe immediate or delayed penicillin hypersensitivity

• This includes anaphylaxis (see below) BUT DOES NOT INCLUDE other life-threatening reactions such as Stevens-Johnson Syndrome (SJS), Toxic epidermal necrolysis (TEN), Drug reaction with eosinophilia and systemic symptoms (DRESS) or interstitial nephritis. If your patient has a history of these, contact infectious diseases for advice

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

OR

OR

Is the infection severe or non-severe?

• Acute bacterial prostatitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is the infection severe or non-severe?

• Acute bacterial prostatitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is the infection severe or non-severe?

• Acute bacterial prostatitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient does not have a penicillin allergy and does not have a contraindication to aminoglycosides give:

Code for gentamicin is: 2abp

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (intravenous + oral) is usually 4 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing. Do not continue empiric gentamicin for more than 48 hours
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Paediatric Gentamicin Dosing (Age < 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• For dosing in children with cystic fibrosis or those receiving chemotherapy, seek expert advice
• For children with impaired renal function (estimated glomerular filtration rate [eGFR] less than 50 mL/min/1.73 m²), give a single dose, then seek expert advice for subsequent dosing or selection of alternative drug. Use the modified Schwartz formula to estimate GFR
• Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides give as a single agent:

Code for ceftriaxone is: 2abp

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (intravenous + oral) is usually 4 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has no penicillin allergy and the infection is not severe give:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy for non-severe acute bacterial protatitis is usually 2 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has no penicillin allergy or non-severe penicillin allergy and the infection is not severe give:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• It is safe to use cefalexin in patients who had a delayed nonsevere reaction to a penicillin in the distant past. It is also safe to use cefalexin in patients who have had a delayed nonsevere reaction recently, unless the reaction involved amoxicillin or ampicillin, because cross-reactivity between these drugs is possible. For patients who have had a recent delayed nonsevere reaction to amoxicillin or ampicillin, use trimethoprim instead
• The total duration of therapy for non-severe acute bacterial protatitis is usually 2 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a severe penicillin allergy and the infection is not severe give:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy for non-severe acute bacterial protatitis is usually 2 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a penicillin allergy but no contraindication to aminoglycosides start treatment as a single agent with:

Code for gentamicin is: 2abp

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (intravenous + oral) is usually 4 weeks
• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing. Do not continue empiric gentamicin for more than 48 hours
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Paediatric Gentamicin Dosing (Age < 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• For dosing in children with cystic fibrosis or those receiving chemotherapy, seek expert advice
• For children with impaired renal function (estimated glomerular filtration rate [eGFR] less than 50 mL/min/1.73 m²), give a single dose, then seek expert advice for subsequent dosing or selection of alternative drug. Use the modified Schwartz formula to estimate GFR
• Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides or previous severe penicillin allergy:

Please contact infectious diseases for advice, treatment is complex

• Acute bacterial prostatitis is caused by similar organisms to those associated with other UTIs (eg Escherichia coli, Proteus species, Klebsiella species). However, sexually transmitted pathogens (ie Chlamydia trachomatis, Neisseria gonorrhoeae) may also cause acute bacterial prostatitis. Systemic pathogens (eg Burkholderia pseudomallei; see Melioidosis) rarely cause infection, except in tropical regions of Australia
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage
• Confirm the infection has resolved by repeating urine culture 1 week after treatment is completed
• Modify empirical therapy based on the results of culture and susceptibility testing

Does the patient have a penicillin allergy? See below for details on penicillin allergy severity

• No penicillin allergy
• Non-severe immediate or delayed penicillin hypersensitivity
• Severe immediate or delayed penicillin hypersensitivity

History of penicillin allergy or adverse reaction

No penicillin allergy

• This includes non-severe reactions such as nausea and limited diarrhoea
• Such reactions are frequently not replicable or generalizable to the whole class. It is safe to prescribe penicillin class antibiotics (with the patient’s knowledge), and if required, use strategies for symptom control such as metoclopramide

Non-severe immediate or delayed penicillin hypersensitivity

• This includes non-severe reactions such as isolated rash
• There is only a 2-3% chance of cephalosporin allergy in a patient with a previous IgE mediated allergy to penicillin, and probably even less for other types of allergies. In most cases it is safe to administer a cephalosporin to a patient who has had a non-life threatening reaction to penicillin

Severe immediate or delayed penicillin hypersensitivity

• This includes anaphylaxis (see below) BUT DOES NOT INCLUDE other life-threatening reactions such as Stevens-Johnson Syndrome (SJS), Toxic epidermal necrolysis (TEN), Drug reaction with eosinophilia and systemic symptoms (DRESS) or interstitial nephritis. If your patient has a history of these, contact infectious diseases for advice

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

OR

OR

Is the infection severe or non-severe?

• Non-sexually acquired epididymo-orchitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is the infection severe or non-severe?

• Non-sexually acquired epididymo-orchitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is the infection severe or non-severe?

• Non-sexually acquired epididymo-orchitis is considered severe if the patient has fever (38°C or higher), systemic features (eg chills, sweats), or sepsis or septic shock
• If the patient is septic, please also see treatment for sepsis for further advice

• Severe and/or septic
• Non-severe

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient does not have a penicillin allergy and does not have a contraindication to aminoglycosides give:

Code for gentamicin is: 2abp

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The usual treatment duration is 14 days (intravenous + oral)
• Epididymo-orchitis most commonly occurs as a complication of a urethral infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae in men who are sexually active, or a urinary tract infection caused by enteric Gram-negative bacteria. Men who engage in insertive anal sex are at risk of infection with sexually acquired enteric pathogens in addition to other sexually transmitted pathogens. In a significant number of cases, no pathogen is identified
• Please see corresponding eTG section for advice on microbiological diagnosis, if required or consult microbiology
• Acute scrotal pain or inflammation can be a urological emergency. Exclude alternative diagnoses (eg Fournier gangrene [see Necrotising skin and soft tissue infections], testicular torsion, testicular abscess)
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Paediatric Gentamicin Dosing (Age < 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• For dosing in children with cystic fibrosis or those receiving chemotherapy, seek expert advice
• For children with impaired renal function (estimated glomerular filtration rate [eGFR] less than 50 mL/min/1.73 m²), give a single dose, then seek expert advice for subsequent dosing or selection of alternative drug. Use the modified Schwartz formula to estimate GFR
• Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides:

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• If treating acute bacterial prostatitis, the total duration of therapy (intravenous + oral) is usually 4 weeks. If treating epididymo-orchitis the usual treatment duration is 14 days (intravenous + oral)
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has no penicillin allergy and the infection is not severe give:

OR, if resistance to all of the above drugs is confirmed and the pathogen is susceptible, a suitable alternative is:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Please see corresponding eTG section for advice on microbiological diagnosis, if required or consult microbiology

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a severe penicillin allergy and the infection is not severe give:

OR, if resistance to all of the above drugs is confirmed and the pathogen is susceptible, a suitable alternative is:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)
• Acute bacterial prostatitis usually presents with symptoms associated with urinary tract infection (UTI) (eg acute dysuria, urinary frequency and urgency), and systemic features (eg fever [38°C or higher], chills, sweats). Obstructive urinary symptoms (eg weak stream, dribbling, hesitancy or urinary retention) and symptoms suggestive of prostatic involvement (eg pelvic or perineal pressure, or prostate tenderness on gentle digital rectal examination) may also be present
• Acute bacterial prostatitis following genitourinary instrumentation (eg transrectal ultrasound-guided prostate biopsy) is often associated with sepsis and multidrug-resistant Gram-negative bacteria—seek expert advice
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Prostatic abscess can complicate prostatitis. Imaging (eg transrectal ultrasound, CT scan, MRI) can identify prostatic abscesses that may require drainage

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has no penicillin allergy or non-severe penicillin allergy and the infection is not severe give:

OR, if resistance to all of the above drugs is confirmed and the pathogen is susceptible, a suitable alternative is:

Code for ciprofloxacin is: 14abp

This code is valid for FOURTEEN days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two weeks. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• It is safe to use cefalexin in patients who had a delayed nonsevere reaction to a penicillin in the distant past. It is also safe to use cefalexin in patients who have had a delayed nonsevere reaction recently, unless the reaction involved amoxicillin or ampicillin, because cross-reactivity between these drugs is possible. For patients who have had a recent delayed nonsevere reaction to amoxicillin or ampicillin, use trimethoprim instead
• The usual treatment duration is 14 days (intravenous + oral)
• Epididymo-orchitis most commonly occurs as a complication of a urethral infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae in men who are sexually active, or a urinary tract infection caused by enteric Gram-negative bacteria. Men who engage in insertive anal sex are at risk of infection with sexually acquired enteric pathogens in addition to other sexually transmitted pathogens. In a significant number of cases, no pathogen is identified
• Epididymo-orchitis can also develop after urinary tract instrumentation
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Modify therapy based on the results of investigations and clinical response. If pain and swelling have not substantially reduced, oral therapy may need to be continued for up to 3 weeks
• Acute scrotal pain or inflammation can be a urological emergency. Exclude alternative diagnoses (eg Fournier gangrene [see Necrotising skin and soft tissue infections], testicular torsion, testicular abscess)

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a penicillin allergy but no contraindication to aminoglycosides start treatment as a single agent with:

Code for gentamicin is: 2abp

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• The usual treatment duration is 14 days (intravenous + oral)
• Epididymo-orchitis most commonly occurs as a complication of a urethral infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae in men who are sexually active, or a urinary tract infection caused by enteric Gram-negative bacteria. Men who engage in insertive anal sex are at risk of infection with sexually acquired enteric pathogens in addition to other sexually transmitted pathogens. In a significant number of cases, no pathogen is identified
• Epididymo-orchitis can also develop after urinary tract instrumentation
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Modify therapy based on the results of investigations and clinical response. If pain and swelling have not substantially reduced, oral therapy may need to be continued for up to 3 weeks
• Acute scrotal pain or inflammation can be a urological emergency. Exclude alternative diagnoses (eg Fournier gangrene [see Necrotising skin and soft tissue infections], testicular torsion, testicular abscess)
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Paediatric Gentamicin Dosing (Age < 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• For dosing in children with cystic fibrosis or those receiving chemotherapy, seek expert advice
• For children with impaired renal function (estimated glomerular filtration rate [eGFR] less than 50 mL/min/1.73 m²), give a single dose, then seek expert advice for subsequent dosing or selection of alternative drug. Use the modified Schwartz formula to estimate GFR
• Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on epididymo-orchitis or acute bacterial prostatitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides and/or previous severe penicillin allergy:

Please contact infectious diseases for advice, treatment is complex

• Modify empirical therapy based on the results of culture and susceptibility testing. Please contact infectious diseases after 72 hours for advice for ongoing treatment
• The usual treatment duration is 14 days (intravenous + oral)
• Epididymo-orchitis most commonly occurs as a complication of a urethral infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae in men who are sexually active, or a urinary tract infection caused by enteric Gram-negative bacteria. Men who engage in insertive anal sex are at risk of infection with sexually acquired enteric pathogens in addition to other sexually transmitted pathogens. In a significant number of cases, no pathogen is identified
• Epididymo-orchitis can also develop after urinary tract instrumentation
• For prepubertal boys with epididymo-orchitis suspected to be caused by an organism from the urinary tract, perform urinalysis; more than 80% of cases in these patients are not bacterial and do NOT require antibiotic therapy. If urinalysis is negative for leucocyte esterase and nitrite, treat the child symptomatically. If the urinalysis is positive for leucocyte esterase or nitrite, take a midstream urine sample for culture and treat as for a urinary tract infection for 14 days (see the Therapeutic Guidelines section on treatment of urinary tract infections for more details)
• Obtain urine samples for culture and susceptibility testing for patients with acute bacterial prostatitis. For patients in hospital, also collect blood samples for culture and susceptibility testing
• Modify therapy based on the results of investigations and clinical response. If pain and swelling have not substantially reduced, oral therapy may need to be continued for up to 3 weeks
• Acute scrotal pain or inflammation can be a urological emergency. Exclude alternative diagnoses (eg Fournier gangrene [see Necrotising skin and soft tissue infections], testicular torsion, testicular abscess)

Is the infection suspected to be caused by a sexually acquired pathogen or urinary tract pathogen?

• Differentiating the cause of infection (ie a sexually transmitted or urinary tract pathogen) depends on clinical judgment and patient history
• If the diagnosis is uncertain, or urethral discharge is present then treat as sexually acquired
• If the patient is not sexually active, please treat as "Urinary tract associated pathogen"

• Sexually acquired pathogen most likely
• Urinary tract associated pathogen (treat as acute bacterial prostatitis)

Is the infection suspected to be caused by a sexually acquired pathogen or urinary tract pathogen?

• Differentiating the cause of infection (ie a sexually transmitted or urinary tract pathogen) depends on clinical judgment and patient history
• If the diagnosis is uncertain, or urethral discharge is present then treat as sexually acquired
• If the patient is not sexually active, please treat as "Urinary tract associated pathogen"

• Sexually acquired pathogen most likely
• Urinary tract associated pathogen (treat as acute bacterial prostatitis)

Is the infection suspected to be caused by a sexually acquired pathogen or urinary tract pathogen?

• Differentiating the cause of infection (ie a sexually transmitted or urinary tract pathogen) depends on clinical judgment and patient history
• If the diagnosis is uncertain, or urethral discharge is present then treat as sexually acquired
• If the patient is not sexually active, please treat as "Urinary tract associated pathogen"

• Sexually acquired pathogen most likely
• Urinary tract associated pathogen (treat as acute bacterial prostatitis)

If patient has sexually acquired infection and non-severe or no penicillin allergy give:

Code for ceftriaxone is: 1abp

This code is valid for ONE dose only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

Code for oral azithromycin is: 7abp

This code is valid for TWO doses only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past two doses. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Epididymo-orchitis most commonly occurs as a complication of a urethral infection caused by Chlamydia trachomatis or Neisseria gonorrhoeae in men who are sexually active, or a urinary tract infection caused by enteric Gram-negative bacteria. Men who engage in insertive anal sex are at risk of infection with sexually acquired enteric pathogens in addition to other sexually transmitted pathogens. In a significant number of cases, no pathogen is identified
• Epididymo-orchitis can also occur secondary to a number of systemic bacterial infections (eg extrapulmonary tuberculosis, syphilis, brucellosis, melioidosis), viral infections (eg mumps) and non-infective conditions. Or, after urinary tract instrumentation
• Acute scrotal pain or inflammation can be a urological emergency. Exclude alternative diagnoses (eg Fournier gangrene [see Necrotising skin and soft tissue infections], testicular torsion, testicular abscess)
• The usual treatment duration is 14 days (intravenous + oral)
• Please see corresponding eTG section for advice on microbiological diagnosis, if required or consult Microbiology

References:

See section on epididymo-orchitis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Does the patient have a penicillin allergy? See below for details on penicillin allergy severity

• No penicillin allergy
• Non-severe immediate or delayed penicillin hypersensitivity
• Severe immediate or delayed penicillin hypersensitivity

History of penicillin allergy or adverse reaction

No penicillin allergy

• This includes non-severe reactions such as nausea and limited diarrhoea
• Such reactions are frequently not replicable or generalizable to the whole class. It is safe to prescribe penicillin class antibiotics (with the patient’s knowledge), and if required, use strategies for symptom control such as metoclopramide

Non-severe immediate or delayed penicillin hypersensitivity

• This includes non-severe reactions such as isolated rash
• There is only a 2-3% chance of cephalosporin allergy in a patient with a previous IgE mediated allergy to penicillin, and probably even less for other types of allergies. In most cases it is safe to administer a cephalosporin to a patient who has had a non-life threatening reaction to penicillin

Severe immediate or delayed penicillin hypersensitivity

• This includes anaphylaxis (see below) BUT DOES NOT INCLUDE other life-threatening reactions such as Stevens-Johnson Syndrome (SJS), Toxic epidermal necrolysis (TEN), Drug reaction with eosinophilia and systemic symptoms (DRESS) or interstitial nephritis. If your patient has a history of these, contact infectious diseases for advice

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

OR

OR

Is the patient a child? Or adult with mild or severe pyelonephritis?

• Paediatric patient
• Adult, mild pyelonephritis
• Adult, severe pyelonephritis

Mild pyelonephritis is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• If there is resistance to the above agent contact infectious diseases for advice

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient has a contraindication to aminoglycosides as a single drug give:

Code for ceftriaxone is: 3pye

This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (IV + PO) is normally 10 to 14 days, depending on clinical response
• If septic, door to needle time must be within ONE HOUR of recognition of septic shock
• If septic, repeat fluid bolus every 15 minutes until patient is normotensive.
• If patient is not normotensive after administration of > 3L of fluid, move the patient to the resuscitation room ASAP if in ED, inform the supervising medical officer (senior emergency doctor or registrar/consultant if on a ward), refer for urgent ICU assessment. Please see the severe sepsis treatment notes in the Therapeutic Guidelines for more details
• Wherever possible ensure that 2 x blood cultures are taken prior to administration of antibiotics to allow directed therapy
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• Critically ill patients may need a higher dose of ceftriaxone (2 g daily) or may need to be treated as per severe sepsis regimen. See severe sepsis
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• If there is resistance to ceftriaxone or the isolate is Pseudomonas aeruginosa contact the infectious diseases registrar for advice

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient does not have a contraindication to aminoglycosides give:

Code for gentamicin is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (IV + PO) is normally 10 to 14 days, depending on clinical response
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is the patient a child? Or adult with mild or severe pyelonephritis?

• Paediatric patient
• Adult, mild pyelonephritis
• Adult, severe pyelonephritis

• Always choose severe pyelonephritis for any adult if the patient has either high grade fever or nausea and vomiting

Is gentamicin contraindicated in this patient? see below for contraindications

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient has a contraindication to aminoglycosides and previous anaphylaxis with penicillin:

Please contact infectious diseases for advice, a decision needs to be made on whether to use a carbapenem in a monitored critical care environment

If patient has a severe penicillin allergy and does not have a contraindication to aminoglycosides consider use of:

Code for gentamicin or meropenem is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• In patients with penicillin hypersensitivity, the rate of immune-mediated cross-reactivity with carbapenems is approximately 1%; therefore, meropenem can be considered in supervised settings. However, in patients with a history of a severe cutaneous adverse reaction (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome / toxic epidermal necrolysis [SJS/TEN], acute generalised exanthematous pustulosis [AGEP]), consider meropenem only in a critical situation when there are limited treatment options
• The total duration of therapy (IV + PO) is normally 10 to 14 days, depending on clinical response
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is the patient a child? Or adult with mild or severe pyelonephritis?

• Paediatric patient
• Adult, mild pyelonephritis
• Adult, severe pyelonephritis

• Always choose severe pyelonephritis for any adult if the patient has either high grade fever or nausea and vomiting

Mild pyelonephritis is treated with oral antibiotics. For empirical therapy while awaiting the results of cultures and susceptibility testing, use:

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• If there is resistance to the above agent or there is Pseudomonas aeruginosa contact infectious diseases for advice

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient has a contraindication to aminoglycosides as a single agent give:

Code for ceftriaxone is: 3pye

This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

Code for meropenem is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (IV + PO) is normally 10 to 14 days, depending on clinical response
• If septic, door to needle time must be within ONE HOUR of recognition of septic shock
• If septic, repeat fluid bolus every 15 minutes until patient is normotensive.
• If patient is not normotensive after administration of > 3L of fluid, move the patient to the resuscitation room ASAP if in ED, inform the supervising medical officer (senior emergency doctor or registrar/consultant if on a ward), refer for urgent ICU assessment. Please see the severe sepsis treatment notes in the Therapeutic Guidelines for more details
• Wherever possible ensure that 2 x blood cultures are taken prior to administration of antibiotics to allow directed therapy
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• If there is resistance to ceftriaxone or the isolate is Pseudomonas aeruginosa contact the infectious diseases registrar for advice
• Critically ill patients may need a higher dose of ceftriaxone (2 g daily) or may need to be treated as per severe sepsis regimen. See severe sepsis
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient does not have a contraindication to aminoglycosides give:

Code for gentamicin and meropenem is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• The total duration of therapy (IV + PO) is normally 10 to 14 days, depending on clinical response
• If septic, door to needle time must be within ONE HOUR of recognition of septic shock
• If septic, repeat fluid bolus every 15 minutes until patient is normotensive.
• If patient is not normotensive after administration of > 3L of fluid, move the patient to the resuscitation room ASAP if in ED, inform the supervising medical officer (senior emergency doctor or registrar/consultant if on a ward), refer for urgent ICU assessment. Please see the severe sepsis treatment notes in the Therapeutic Guidelines for more details
• Wherever possible ensure that 2 x blood cultures are taken prior to administration of antibiotics to allow directed therapy
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• If there is resistance to ceftriaxone or the isolate is Pseudomonas aeruginosa contact infectious diseases for advice
• Critically ill patients may need a higher dose of ceftriaxone (2 g daily) or may need to be treated as per severe sepsis regimen. See severe sepsis
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity

Initial Gentamicin/Tobramycin Dosing (age > 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• Use the Cockcroft gault calculator to calculate renal function for adults if using the nomogram, or use the adult aminoglycoside dose calculator

References:

See section on pyelonephritis - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is the child younger than 1 month? Or showing signs of severe illness?

• <1 month
• >1 month with severe illness
• >1 month with non-severe illness

• If patient has any risk factors for severe illness (i.e. dehydration, inability to maintain oral intake, immunocompromise) please choose option 1
• Signs of severe illness include sepsis, dehydration or inability to maintain oral intake

Is the child younger than 1 month? Or showing signs of severe illness?

• <1 month
• >1 month with severe illness
• >1 month with non-severe illness

• Signs of severe illness include sepsis, dehydration or inability to maintain oral intake
• If patient has any risk factors for severe illness (i.e. dehydration, inability to maintain oral intake, immunocompromise) please choose option 1

Is the child younger than 1 month? Or showing signs of severe illness?

• <1 month
• >1 month with severe illness
• >1 month with non-severe illness

• Signs of severe illness include sepsis, dehydration or inability to maintain oral intake
• If patient has any risk factors for severe illness (i.e. dehydration, inability to maintain oral intake, immunocompromise) please choose option 1

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient has a contraindication to penicillin for non severe pyelonephritis give:

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• If there is resistance to Bactrim or the isolate is Pseudomonas aeruginosa contact the infectious diseases registrar for advice
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

Is gentamicin contraindicated in this patient? (See below for contraindications)

• Gentamicin not contraindicated
• Gentamicin contraindicated

Aminoglycoside Contraindications and Precautions

• A single dose can be used in patients with:
  • Chronic renal impairment (creatinine clearance less than 40 mL/min) or rapidly deteriorating renal function
  • Advanced age (eg 80 years or older), depending on calculated renal function
• If you are unsure whether gentamicin is appropriate for this patient please consult infectious diseases

If patient has a contraindication to penicillin for non severe pyelonephritis give:

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• If there is resistance to the above agents or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If there is resistance to the above agents or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on acute cystitis in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides give as a single agent:

Code for cefotaxime is: 3pye

This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• Contact a paediatrician for review of all cases of pyelonephritis in children < 1 month of age
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• If there is resistance to cefotaxime or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides give as a single agent:

Code for ceftriaxone is: 3pye

This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• If there is resistance to ceftriaxone or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient does not have a contraindication to aminoglycosides give as a single agent:

Code for gentamicin is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• If ongoing gentamicin therapy is required, AUC monitoring should be performed in collaboration with pharmacy. Please contact pharmacy before the third dose for instructions
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• If treating a neonate gentamicin dosing must be tailored based on postmenstrual age and weight, please see the gentamicin dosing nomogram
• Contact a paediatrician for review of all cases of pyelonephritis in children < 1 month of age
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• See the Therapeutic Guidelines - Clinical Monitoring for aminoglycoside toxicity section for more information on monitoring for possible aminoglycoside toxicity
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides and penicillin hypersensitivity:

Please contact infectious diseases for advice

• It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient does not have a contraindication to aminoglycosides give as a single agent:

Code for gentamicin is: 2pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• If ongoing gentamicin therapy is required, AUC monitoring should be performed in collaboration with pharmacy. Please contact pharmacy before the second dose for instructions
• For neonate dosing please refer to the Therapeutic Guidelines: Antibiotic
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Contact a paediatrician for review of all cases of pyelonephritis in children < 1 month of age
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides give as a single agent:

Code for ceftriaxone is: 3pye

This code is valid for THREE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 72 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Ceftriaxone is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• If there is resistance to ceftriaxone or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has a contraindication to aminoglycosides give as a single agent:

Code for cefotaxime is: 3pye

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Cefotaxime is not effective against Pseudomonas aeruginosa, enterococci or organisms that produce extended-spectrum beta-lactamase (ESBL) enzymes
• If there is resistance to cefotaxime or the isolate is Pseudomonas aeruginosa contact the paediatric infectious diseases registrar for advice
• Contact a paediatrician for review of all cases of pyelonephritis in children < 1 month of age
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient does not have a contraindication to aminoglycosides give:

Code for gentamicin is: 2pye

This code is valid for TWO days only. Starting from the first day of treatment for this condition. Infectious diseases must be contacted within 48 hours for review of this patient. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• If long term gentamicin therapy is required AUC monitoring should be performed early with the first dose in collaboration with pharmacy. AUC monitoring MUST be performed if more than three doses are to be given
• This is a guide for empirical treatment only. It is imperative that mid stream urine samples for culture and susceptibility testing are taken prior to administration of antibiotics for targeted therapy
• Contact a paediatrician for review of all cases of pyelonephritis in children < 1 month of age
• Consider an early change to oral antibiotics if patient remains afebrile for 24-48 hours. Please see the recommended IV duration in the Therapeutic Guidelines for details on when to make the oral switch
• Use culture and susceptibility data to guide ongoing therapy within 72 hours of initiating gentamicin and consider conversion to oral therapy if appropriate
• Consult local neonatal medication guidelines for further recommendations when treating neonates

References:

See section on urinary tract infections in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Does the patient have cystitis or pyelonephritis?

• catheter associated cystitis
• cystitis
• pyelonephritis

Consider the diagnosis of catheter-associated urinary tract infection (CA-UTI) in catheterised patients with signs and symptoms, including fever (38°C or higher), rigors, acute mental state change, flank pain, acute haematuria, or pelvic discomfort

Do not investigate (with urinalysis or urine culture) catheterised patients with nonspecific symptoms

Bacteriuria, pyuria, and cloudy or malodourous urine are not reliable signs of CA-UTI in the absence of genitourinary symptoms. Inappropriate investigation (with urinalysis or urine culture) of asymptomatic patients can result in the incorrect diagnosis and treatment of CA-UTI

Urine samples for culture are often collected inappropriately as part of an evaluation of fever in patients with a catheter who do not have genitourinary symptoms. The incidence of bacteriuria associated with an indwelling urinary catheter is between 3 and 8% per day. Therefore, after a month, almost all patients with a catheter will have bacteriuria. Asymptomatic catheter-associated bacteriuria rarely results in adverse outcomes. Do not screen for or treat catheter-associated asymptomatic bacteriuria except in specific circumstances— see the Therapeutic Guidelines for Asymptomatic bacteriuria in adults

The absence of pyuria in a symptomatic catheterised patient suggests a diagnosis other than UTI

Guide to collecting urine samples in patients with indwelling urinary catheters

Remove the indwelling catheter and obtain a midstream urine sample

OR (if ongoing catheterisation is required)

Replace the catheter [NB1], then collect a urine sample from the port in the drainage system, or if this is not possible, by separating the catheter from the drainage system

Do not collect a urine sample from the drainage bag for culture.

Ensure the pathology request clearly indicates that the urine sample provided for testing was obtained via a catheter

NB1: The catheter must be replaced before collecting the urine sample to avoid culture of bacteria present in the biofilm of the catheter but not in the bladder

• Continue to treatment

• See the Therapeutic Guidelines section on catheter associated urinary tract infections in adults for more information

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)

• No penicillin allergy
• Non-severe immediate or delayed penicillin hypersensitivity
• Severe immediate or delayed penicillin hypersensitivity

History of penicillin allergy or adverse reaction

No penicillin allergy

• This includes non-severe reactions such as nausea and limited diarrhoea
• Such reactions are frequently not replicable or generalizable to the whole class. It is safe to prescribe penicillin class antibiotics (with the patient’s knowledge), and if required, use strategies for symptom control such as metoclopramide

Non-severe immediate or delayed penicillin hypersensitivity

• This includes non-severe reactions such as isolated rash
• There is only a 2-3% chance of cephalosporin allergy in a patient with a previous IgE mediated allergy to penicillin, and probably even less for other types of allergies. In most cases it is safe to administer a cephalosporin to a patient who has had a non-life threatening reaction to penicillin

Severe immediate or delayed penicillin hypersensitivity

• This includes anaphylaxis (see below) BUT DOES NOT INCLUDE other life-threatening reactions such as Stevens-Johnson Syndrome (SJS), Toxic epidermal necrolysis (TEN), Drug reaction with eosinophilia and systemic symptoms (DRESS) or interstitial nephritis. If your patient has a history of these, contact infectious diseases for advice

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

OR

OR

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Catheter-associated urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples (taken as per above) for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on catheter-associated urinary tract infection - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Does the patient have a penicillin allergy? (See below for details on penicillin allergy severity)

• No penicillin allergy
• Non-severe immediate or delayed penicillin hypersensitivity
• Severe immediate or delayed penicillin hypersensitivity

History of penicillin allergy or adverse reaction

No penicillin allergy

• This includes non-severe reactions such as nausea and limited diarrhoea
• Such reactions are frequently not replicable or generalizable to the whole class. It is safe to prescribe penicillin class antibiotics (with the patient’s knowledge), and if required, use strategies for symptom control such as metoclopramide

Non-severe immediate or delayed penicillin hypersensitivity

• This includes non-severe reactions such as isolated rash
• There is only a 2-3% chance of cephalosporin allergy in a patient with a previous IgE mediated allergy to penicillin, and probably even less for other types of allergies. In most cases it is safe to administer a cephalosporin to a patient who has had a non-life threatening reaction to penicillin

Severe immediate or delayed penicillin hypersensitivity

• This includes anaphylaxis (see below) BUT DOES NOT INCLUDE other life-threatening reactions such as Stevens-Johnson Syndrome (SJS), Toxic epidermal necrolysis (TEN), Drug reaction with eosinophilia and systemic symptoms (DRESS) or interstitial nephritis. If your patient has a history of these, contact infectious diseases for advice

Penicillin anaphylaxis is highly likely if any ONE of the following is fulfilled:

OR

OR

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient
• child > 1 month old
• child < 1 month old

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient
• child > 1 month old
• child < 1 month old

Is the patient a child, male, female or pregnant?

• nonpregnant woman
• pregnant woman
• adult male patient
• child > 1 month old
• child < 1 month old

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• Avoid using nitrofurantoin close to delivery (after 37 weeks gestation, or sooner if early delivery is planned) because of the possible increased risk of neonatal jaundice and haemolytic anaemia
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• Avoid using nitrofurantoin close to delivery (after 37 weeks gestation, or sooner if early delivery is planned) because of the possible increased risk of neonatal jaundice and haemolytic anaemia
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• Avoid using nitrofurantoin close to delivery (after 37 weeks gestation, or sooner if early delivery is planned) because of the possible increased risk of neonatal jaundice and haemolytic anaemia
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children

References:

See section on acute cystitis in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children

References:

See section on acute cystitis in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in children - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

If patient has no penicillin allergy and is at risk of MRSA infection and is showing signs of sepsis use:

Code for gentamicin is: 2uti

This code is valid for TWO days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 48 hours. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children
• If there are concerns for pyelonephritis then please see the pyelonephritis section

Initial Paediatric Gentamicin Dosing (Age < 12 years)

• If actual body weight is more than 20% over the ideal body weight, use adjusted body weight to calculate the dose. For morbidly obese patients, seek expert advice
• Critically ill patients with severe sepsis have higher volumes of distribution. In these patients a dose of up to 7mg/kg may be appropriate (depending on renal function). See the Therapeutic Guidelines for more detail
• For dosing in children with cystic fibrosis or those receiving chemotherapy, seek expert advice
• For children with impaired renal function (estimated glomerular filtration rate [eGFR] less than 50 mL/min/1.73 m²), give a single dose, then seek expert advice for subsequent dosing or selection of alternative drug. Use the modified Schwartz formula to estimate GFR
• Postmenstrual age is the time elapsed between the first day of the last menstrual period and birth (gestational age) plus the time elapsed after birth (postnatal age)

References:

See the CHAMP guidelines - See local protocol for urinary tract infections in the CHAMP guidelines

If patient has non-severe immediate or delayed penicillin hypersensitivity and is at risk of MRSA infection and is showing signs of sepsis use:

Code for cefotaxime is: 5uti

This code is valid for FIVE days only, starting from the first day of treatment for this condition. Infectious diseases must be contacted if IV treatment is to continue past 5 days. Please annotate this code on the medication chart and document when infectious diseases are to be contacted in the patient notes.

• Continue treatment for 5 days in children younger than 1 month, or for 3 days in children 1 month or older
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• Please refer to the CHAMP guidelines for further information on treating urinary tract infections in children
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See the CHAMP guidelines - See local protocol for urinary tract infections in the CHAMP guidelines

Urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.

Urinary tract infection treatment:

• All adult men presenting with a UTI require further investigation to look for prostatitis or abnormality which may cause a UTI
• This is a guide for empirical treatment only. Mid stream urine samples for culture and susceptibility testing should be taken prior to administration of antibiotics for targeted therapy.
• Do not use nitrofurantoin unless the patient is afebrile and prostatitis is considered unlikely, because therapeutic concentrations of nitrofurantoin are not reached in the prostate
• If culture and susceptibility testing indicate the pathogen is resistant to empirical therapy, do not modify therapy if symptoms of cystitis are improving
• Take care prescribing nitrofurantoin in a patient with kidney disease, it is generally contraindicated if eGFR is <45mL/min as it will not achieve high enough concentrations in urine to treat the infection and may cause adverse effects due to high plasma concentrations
• If the patient has a catheter ideally this should be removed prior to treatment (or at least changed). If the patient is likely to require ongoing long term catheterisation it may be worth discussing with infectious diseases
• Asymptomatic bacteriuria usually should not be treated, except in pregnant women
• If there are concerns for pyelonephritis then please see the pyelonephritis section

References:

See section on acute cystitis in adults - Antibiotic Expert Groups. Therapeutic guidelines: antibiotic. Version 15. Melbourne: Therapeutic Guidelines Limited; 2019.