Review of drug options for UTI bugs (that are commonly used in the UK):

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Mapping on to the spectrum of the commonest UTI bugs we get this:

Urine Drug Penetrance.png

Urine drug concentrations

NICE Recommendations

ESCMID Recommendations for treating MDR Gram negative cUTI +/- BSI

PO Stepdown post-bacteraemia: Any high-bioavailability agent will do:

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Duration

The Rationalisation for this Episode

Item Authors DoI/link Notes
UTI (lower): antimicrobial prescribing NICE https://www.nice.org.uk/guidance/ng109/resources/visual-summary-pdf-6544021069
Pyelonephritis (acute): antimicrobial prescribing NICE https://www.nice.org.uk/guidance/ng111/resources/visual-summary-pdf-6544161037
European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guidelines for the treatment of infections caused by multidrug-resistant Gram-negative bacilli (endorsed by European society of intensive care medicine) ESCMID https://doi.org/10.1016/j.cmi.2021.11.025 Europe advice for MDR gram-negatives
Treatment of Ampicillin-Resistant Enterococcus faecium Urinary Tract Infections. Richey et al. PMID: 30766068 Documented the treatment of Amp-R Enterococci with amoxicillin
Urinary Tract Infections in Patients with Chronic Renal Insufficiency Gilbert DN 10.2215/CJN.01931105 Brilliant paper on renal penetrance of various antibiotics. Table 1 in particular is worth memorising
An infectious disease and pharmacokinetic perspective on oral antibiotic treatment of uncomplicated urinary tract infections due to multidrug-resistant Gram-negative uropathogens: the importance of urinary antibiotic concentrations and urinary pH Cunha BA 10.1007/s10096-016-2577-0 Has information on doxycycline treatment of pseudomonas in urine. Also notes the effect of pH on antibiotic effectiveness
Pharmacological properties of oral antibiotics for the treatment of uncomplicated urinary tract infections Novelli A, Rosi E 10.1080/1120009X.2017.1380357 Nice general run-through of the PK of drugs commonly used for UTIs in europe
Oral β-Lactam Antibiotics vs Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Definitive Treatment of Enterobacterales Bacteremia From a Urine Source Sutton JD et al 10.1001/jamanetworkopen.2020.20166 Comparison of FQ/Cotrim vs beta-lactams (Co-amoxiclav, Amoxicillin, Cephalexin, Cefpodoxime); composite outcome of 30d death or recurrent BSI; no difference.