Antibiotic therapy

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• Older people are vulnerable to infection, particularly Clostridioides difficile infection, therefore use of broad spectrum antibiotics such as ciprofloxacin, coamoxiclav and cephalosporins should be avoided if possible.
• First choice antibiotics for uncomplicated lower UTI in non-catheterised patients are trimethoprim 200mg twice daily or nitrofurantoin 50mg four times daily (or nitrofurantoin MR 100mg twice daily). Recommended course duration is three days for women and seven days for men.
• BNF suggests avoid nitrofurantoin if eGFR < 45ml/ min/1.73m3 but can be used with caution if GFR 30- 44ml/min/1.73m3 as a short course only (3-7 days).
• In men, if there is clinical suspicion of acute prostatitis (suggested by fever and pain at the base of the penis, around the anus, just above the pubic bone and/or in the lower back), a 28 day course of ciprofloxacin or ofloxacin is recommended. Trimethoprim may be used if the organism is sensitive.
• In catheterised patients with symptoms of UTI, a seven day course of antibiotics, following local antibiotic guidelines is recommended in both men and women. The catheter should be removed then replaced if necessary.
• Second choice antibiotics should always be guided by urine culture and history of antibiotic use.