Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

with urinary tract infection (UTI)

1st line – oral antibiotic therapy

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ACUTE
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with urinary tract infection (UTI)
1st line – 

oral antibiotic therapy

Fluoroquinolones are appropriate for the treatment of complicated UTIs (anatomical and functional abnormalities of the genitourinary tract), although the US Food and Drug Administration and the European Medicines Agency warn that fluoroquinolones are associated with disabling and potentially permanent side effects involving tendons, muscles, joints, nerves, and the central nervous system.[35][36][37] Other antibiotics (e.g., trimethoprim/sulfamethoxazole, nitrofurantoin) may be used based on local resistance patterns.[38] The decision whether to admit the patient for intravenous antibiotic treatment should be based on patients' symptoms and comorbidities. See Acute pyelonephritis.

Antibiotic dosing may need to be altered based on the patient's renal status.

Recommended treatment duration is 14 days, but patients with uncomplicated UTI may require only a 7-day course of antibiotics.

Primary options

levofloxacin: 500 mg orally once daily

OR

ciprofloxacin: 500 mg orally twice daily

Secondary options

trimethoprim/sulfamethoxazole: 160/800 mg orally twice daily

Tertiary options

nitrofurantoin: 100 mg orally four times daily

OR

amoxicillin/clavulanate: 500 mg orally three times daily; or 875 mg orally twice daily

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OR

cefalexin: 500 mg orally four times daily

with nephrolithiasis

1st line – hydration and dietary modification

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ACUTE
|
with nephrolithiasis
1st line – 

hydration and dietary modification

Patients with renal stones and MSK are managed in the same way as those without MSK.[3]

Recurrent stones may not be preventable with the anatomical abnormality of MSK. However, risk factors identified through 24-hour urine stone-risk profiles may be used to direct diet modification and medication.[3][39][40][41][42][43]

One retrospective study showed potassium citrate not only increased urine citrate but decreased hypercalciuria in patients with metabolic stone risk factors.[43]

Fluid intake should be increased to >2 L/day to keep urine output high and reduce risk of both renal stones and UTI.[44]

Plus – treatment of underlying cause

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ACUTE
|
with nephrolithiasis
Plus – 

treatment of underlying cause

Treatment recommended for ALL patients in selected patient group

Underlying cause for renal stones should be investigated and treated. If required, stones should be removed.

Consider – thiazide diuretics

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ACUTE
|
with nephrolithiasis
Consider – 

thiazide diuretics

Additional treatment recommended for SOME patients in selected patient group

May be used in patients with evidence of nephrocalcinosis to reduce hypercalciuria and stone formation.[45][46]

Primary options

hydrochlorothiazide: 12.5 to 50 mg/day orally given in 2 divided doses

OR

chlortalidone: 12.5 to 50 mg/day orally

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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