Remember to check allergy status
Catheter in situ: antibiotics will not eradicate asymptomatic bacteriuria: only treat if systemically unwell or pyelonephritis likely2 B+
Do not use prophylactic antibiotics for catheter changes unless history of catheter-change-associated UTI or trauma3 B (NICE & SIGN guidance).
UTI in adults (no fever or flank pain)PHE Urine
Women mild/or ≤ 2 symptoms AND
a) Urine NOT cloudy 97% negative predictive value,
do not treat unless other risk factors for infection.
b) If cloudy urine use dipstick to guide treatment.
Nitrite plus blood or leucocytes has 92% positive
predictive value; nitrite, leucocytes, blood all negative 76% NPV 4A-
c) Consider a back-up / delayed antibiotic option 20A
Men: Consider prostatitis and send pre-treatment MSU 1,5C OR if symptoms mild/non-specific, use negative dipstick to exclude UTI 6C
Always safety net.
First line: nitrofurantoin if GFR over 45ml/min 24-5
GFR 30-45ml/min: only use if resistance & no alternative
In Treatment failure: perform culture in all 1B
Use nitrofurantoin first line as general resistance and community multi-resistant Extended-spectrum Beta-lactamase E. coli are increasing. Trimethoprim (if low risk of resistance) and pivmecillinam are alternative first line agents.
Risk factors for increased resistance include:
-care home resident,
-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 19
If increased resistance risk, send culture for susceptibility testing & give safety net advice.
If GFR<45 ml/min or elderly, consider pivmecillinam 21-3,28 or fosfomycin (3g stat in women 15,16B, 17A plus 2nd 3g dose in men 3 days later 18)
200mg TDS (400mg TDS if resistance risk)
UTI in pregnancyPHE Urine
Recurrent UTI in non-pregnant women ≥ 3 UTIs/year