● Current workflow: Start keflex (cephalexin) and send urinalysis with reflex urine culture orders at same time. Counsel the family to OBTAIN urine sample BEFORE the first antibiotic use otherwise it wipes out the urine culture (i.e. we can't tell if the antibiotic will work)

● If there is an allergy to penicillin, counsel there may be cross-over reactions but we can monitor

● If there is an allergy to cephalasporins, do bactrim DS (use SS - single strength if decreased GFR)

● If there is an allergy to PCN, cephalasporins, and bactrim, okay to use macrobid (we usually only use this in those <65) if GFR >30

● If allergy to all the above or macrobid is contraindicated, use fluoroquinolone like cipro

● If contraindication to all the above, then linezolid, but this is expensive.

● Use short term dosing ie 7 days for the empiric treatment

● Finally, if someone has a contraindication to all oral antibiotic options (including multi-drug resistant bugs), we can arrange for gentamycin IV home infusion

Version: YT 11/26/2024