Empirical therapy for sepsis without septic shock from a urinary tract source in nonpregnant adults

The following regimens apply to nonpregnant adults with sepsis from a urinary tract source who do not have septic shock (see Definition of sepsis and septic shock in adults).

For adults with septic shock from a urinary tract source, see Empirical therapy for septic shock from a urinary tract source in adults.

For pregnant adults with sepsis without septic shock, see Empirical therapy for sepsis without septic shock from a urinary tract source in pregnancy.

See Approach to managing sepsis and septic shock from a urinary tract source in adults for a discussion of antibiotic choice.

For empirical therapy for sepsis without septic shock from a urinary tract source in nonpregnant adults, use:

1gentamicin intravenously; see Gentamicin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing gentamicin gentamicin gentamicin

1tobramycin intravenously; see Tobramycin initial dose calculator for adults for initial dose. See Principles of aminoglycoside use for prescribing considerations and subsequent dosing tobramycin tobramycin tobramycin

2ceftriaxone 2 g intravenously, daily. ceftriaxone ceftriaxone ceftriaxone

For nonpregnant adults who have contraindications or precautions that preclude aminoglycoside use, use ceftriaxone (as above).

For nonpregnant adults who have had a nonsevere (immediate or delayed) hypersensitivity reaction to a penicillin, any of the above regimens can be used.

For nonpregnant adults who have had a severe (immediate or delayed)¹ hypersensitivity reaction to a penicillin, use gentamicin or tobramycin (as above) and seek expert advice.

For nonpregnant adults with sepsis without septic shock from a urinary tract source who are at risk of infection with multidrug-resistant gram-negative bacteria, while awaiting results of susceptibility testing and expert advice, replace the empirical regimens above with:

meropenem 1 g intravenously 8-hourly². For dosage adjustment in adults with kidney impairment, see meropenem dosage adjustment.meropenem meropenem meropenem

Empirical antibiotic regimens are intended for initial therapy only (up to 48 hours). Modify therapy as soon as additional information is available (eg results of Gram stain, culture and susceptibility testing of urine or blood samples). Evaluate appropriateness of antibiotic therapy daily, with consideration given to the patient’s clinical status and the principles of antimicrobial stewardship.

Once the patient has clinically improved, for modification and duration of therapy, see Acute pyelonephritis in adults or Acute bacterial prostatitis.

¹ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse. Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

² 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]), consider meropenem only in a critical situation when there are limited treatment options.Return