Uncomplicated Lower Urinary Tract Infection
Antimicrobial prescribing: NHS Fife
Clinical features
diagnosis of urinary tract infections in non-pregnant women 16-65 yrs
diagnosis of urinary tract infection in women over 65 yrs
diagnosis of urinary tract infection in men over 16 yrs
Dipstick findings with no clinical features of UTI are not diagnostic and are not an indication to start treatment or to culture urine
Do not use dipsticks for women > 65 or for men
Signs and symptoms of lower UTI include dysuria, frequency, suprapubic pain, urgency, polyuria, nocturia, visible haematuria, new/worse incontinence, new change in behaviour i.e. patient unable to feed themself or wash hands and face
Investigation
- Urine culture if indicated
- In symptomatic patients under the age of 30, consider gonorrhoea and chlamydia (e.g. itch, discharge)
Infection Control
Basic universal precautions
Treatment
NITROFURANTOIN PO 100mg (MR) 12 hourly or 50mg 6 hourly
OR
TRIMETHOPRIM PO 200mg 12 hourly
Avoid trimethoprim in pregnancy
If oral therapy is not possible, treat as for urinary sepsis
Avoid nitrofurantoin if eGFR is <45. Seek Microbiology advice if no suitable oral option can be prescribed from those reported
Monitor elderly patients prescribed trimethoprim for evidence of renal impairment and hyperkalaemia
Duration: 3-5 days (women); 7 days (men)
In women, 3 days will treat symptoms for most; 5 days may be appropriate in selected cases where bacterial eradication is considered important, weighed against increased risk of adverse drug effects