UTI in Adults (No Fever or Flank Pain)
NHSL Antimicrobial Guidelines
UTI in adults (no fever or flank pain)
CKS: Urinary tract infection (lower) - men
CKS: Urinary tract infection (lower) - women
OLE Course: Urinary Tract Infection
PHE: Guidance: Urinary tract infection: diagnostic tools for primary care
SAPG: Management of recurrent urinary tract infection (UTI) in non-pregnant women
Treat women with severe/or ≥ 3 symptoms;
Assess women with mild/or ≤ 2 symptoms; Treat with pain relief, and consider back-up/delayed antibiotic. Obtain urine specimen and exclude UTI if urine not cloudy or dipstick test negative.
Urine NOT cloudy 97% negative predictive value, do not treat unless other risk factors for infection. If cloudy urine use dipstick to guide treatment. Nitrite plus blood or leucocytes has 92% positive predictive value; nitrite, leucocytes, blood all negative 76% Negative Predictive Value (NPV).
Men: Consider prostatitis and send pre-treatment MSU OR if symptoms mild/non-specific, use negative dipstick to exclude UTI.
Always safety net.
In treatment failure: always perform culture.
People > 65 years: do not treat asymptomatic bacteriuria; it is common but is not associated with increased morbidity.
Catheter in situ: antibiotics will not eradicate asymptomatic bacteriuria; only treat if systemically unwell or pyelonephritis likely. CSU should be sent and catheter changed before starting antibiotics. Treat patient as per guidelines above or see the Acute Pyelonephritis guideline.
Do not use prophylactic antibiotics for catheter changes unless history of catheter-change-associated UTI or trauma (NICE: CG139).
Drug details
Drug
First Line:
Trimethoprim
Dosage
200mg BD
Duration
Women all ages: 3 days
Men: 7 days
Drug
Second Line: Nitrofurantoin
GFR over 40ml/min
Reference: Ashley, C. (ed.) and Dunleavy, A. (ed.) (2014) The renal drug handbook: the ultimate prescribing guide for renal practitioners. 4th edn. London, New York: Radcliffe Publishing.
Dosage
100mg m/r BD
Duration
Women all ages: 3 days
Men: 7 days
Drug
Fosfomycin
Dosage
Women: 3g stat dose
Men: 3g stat dose
2nd 3g dose in men 3 days later
Dosage
400mg TDS
Duration
Women all ages: 3 days
Men: 7 days
Drug
If organism susceptible:
Amoxicillin
Dosage
500mg TDS
Duration
Women all ages: 3 days
Men: 7 days
Risk factors for increased resistance include: care home resident, recurrent UTI, hospitalisation >7d in the last 6 months, unresolving urinary symptoms, recent travel to a country with increased antimicrobial resistance (outside Northern Europe and Australasia) especially health related, previous known UTI resistant to trimethoprim, cephalosporins or quinolones.
If increased resistance risk, send culture for susceptibility testing & give safety net advice. If GFR<40 ml/min or elderly consider Fosfomycin (3g stat in womenplus 2nd 3g dose in men 3 days later) or Pivmecillinam 400mg TDS.