Lower Urinary Tract Infection
- Micro-organism
Coliforms and Enterococcal
- Duration
Total duration: women 3 days (7 days if catheterised); men 7 days
Trimethoprim 200mg 12 hourly
OR
Nitrofurantoin M/R 100mg 12 hourly (avoid if CrCl < 40mL/min)
Catheterised patients :
Only treat if systemically unwell or pyleonephritis likely – antibiotics will not eradicate asymptomatic bacteriuria.
Change catheter – only use prophylactic antibiotics in patients with a history of catheter change-associated UTI or trauma (NICE, SIGN).
Send pre-treatment CSU
Start empirical antibiotics
- Notes
Under 65 years and suspected LUTI
Treat women with severe / ≥ 3 symptoms
Assess women with mild/ ≤ 2 symptoms:
- Obtain urine specimen and exclude UTI if urine not cloudy or dipstick negative
- Treat with pain relief
- Consider delayed (48 hour) prescription
Men
- Consider prostatitis
- Send pre-treatment MSU or if symptoms mild/non-specific, use negative dipstick to exclude UTI
In treatment failure, always perform urine culture
Over 65 years
Do not treat asymptomatic bacteruria – it is common but not associated with increased morbidity.
Useful Resources
SIGN 88: Management of suspected UTI in non-pregnant women
SIGN 88: Management of suspected UTI in men
Doses may need to be adjusted in renal impairment. Always check BNF for interactions. Seek advice if patient pregnant
Drug specific cautions:
- Check interactions in the BNF. Caution may prolong QT interval.
- Avoid Doxycycline and Co-trimoxazole if pregnant or breast feeding
- Gentamicin/Vancomycin refer to online calculators
- ALERT antibiotic needs ALERT form
- Monitor sodium
- See CURB65 definition
- Reference: The Renal Drug Handbook 4th Edition, 2014