Lower UTI without sepsis

Antimicrobial prescribing: NHS Forth Valley
NHS Forth Valley

First Line

Therapy

Trimethoprim 200 mg PO 12 hourly

or

*Nitrofurantoin MR 100mg PO 12 hourly

or

Pivmecillinam 400mg PO STAT, then 200mg 8 hourly (to a total course of 10 tablets)

Notes:

* Nitrofurantoin is contra-indicated in patients with an CrCl < 45ml/min however a short course (3-7 days) may be used with caution in patients with an CrCl 30-44ml/min with suspected or proven multidrug resistant pathogens. Toxic plasma concentrations can occur particularly in the elderly causing adverse effects eg neuropathy, blood dyscrasias. 

Notes

Use of dipsticks for diagnosis of UTI in women aged 65 years and above in long-term care facilities or in frail elderly people requiring assisted living services is not recommended. (SIGN 160)

Send urine specimen for women aged 65 years and above and all male patients before commencing antibiotics to confirm pathogen and antibiotic susceptibility.

Asymptomatic bacteriuria in patients aged 65 years and above is common and not associated with increased morbidity ⇒ does not require treatment

Do not use amoxicillin alone unless supported by recent urine culture sensitivity

Ciprofloxacin should not be used first line for uncomplicated UTI 

 

Treatment duration: 3 days for Female patients and 7 days for Male patients