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Antibiotics for non-pregnant women and men aged 16 years and over

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

Treatment

  • Oral or intravenous antibiotics
    • oral antibiotics should be given first line if the person can take oral medicines, and the severity of their condition does not require intravenous antibiotics
    • if intravenous antibiotics then review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible

Reassessment

  • reassess if symptoms worsen at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:
    • other possible diagnoses
    • any symptoms or signs suggesting a more serious illness or condition, such as sepsis
    • previous antibiotic use, which may have led to resistant bacteria.

Antibiotics1 for non-pregnant women and men aged 16 years and over

First-choice oral antibiotic2

  • cefalexin - 500 mg twice or three times a day (up to 1 to 1.5 g three or four times a day for severe infections) for 7 to 10 days
    • OR
  • co-amoxiclav (only if culture results available and susceptible) - 500/125 mg three times a day for 7 to 10 days
    • OR
  • trimethoprim (only if culture results available and susceptible) - 200 mg twice a day for 14 days
    • OR
  • ciprofloxacin (consider safety issues3) - 500mg twice a day for 7 days

First choice intravenous antibiotics (if vomiting, unable to take oral antibiotics, or severely unwell). Antibiotics may be combined if susceptibilty or sepsis a concern 2, 4

  • co-amoxiclav (only in combination or if culture results available and susceptible)
    • 1.2 g three times a day Cefuroxime 750 mg to 1.5 g three or four times a day

    • OR
  • ceftriaxone
    • 1 to 2 g once a day

    • OR
  • ciprofloxacin (consider safety issues3)
    • 400 mg twice or three times a day

    • OR
  • gentamicin
    • Initially 5 mg/kg to 7 mg/kg once a day, subsequent doses adjusted according to serum gentamicin concentration5

    • OR
  • amikacin Initially
    • 15 mg/kg once a day (maximum per dose 1.5 g once a day), subsequent doses adjusted according to serum amikacin concentration (maximum 15 g per course)

  • 1 check British national formulary (BNF) for appropriate use and dosing in specific populations, for example, hepatic impairment, renal impairment and breastfeeding, and administering intravenous antibiotics.
  • 2 check any previous urine culture and susceptibility results and antibiotic prescribing and choose antibiotics accordingly.
  • 3 the European Medicines Agency's Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system (press release October 2018), but they are an option in acute pyelonephritis, which is a severe infection.
  • 4 review intravenous antibiotics by 48 hours and consider stepping down to oral antibiotics where possible.
  • 5 Therapeutic drug monitoring and assessment of renal function is required (BNF, August 2018)

Reference:


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