UTI in Adults (no fever or flank pain)

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 Pyelonephritis guideline.

Do not use prophylactic antibiotics for catheter changes unless history of catheter-change-associated UTI or trauma (NICE, SIGN).


First Line: Trimethoprim 

200mg BD

Women all ages 3 days

Men 7 days

Second Line: Nitrofurantoin

GFR over 40ml/min

(Reference - Ashley.C , A. Dunleavy ; The Renal Drug Handbook: The Ultimate Prescribing Guide for Renal Practitioners, 4th Edition. 29 May 2014.)

100mg m/r BD

Women all ages 3 days

Men 7 days





NHSL Fosfomycin policy link

3g stat dose in women

Men 3g stat dose

2nd 3g dose in men 3 days later

Women all ages 3 days

Men 7 days

Pivmecillinam (contains penicillin) 



NHSL Pivmecillinam policy link

400mg TDS

Women all ages 3 days

Men 7 days

If organism susceptible: Amoxicillin

500mg TDS

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 women plus 2nd 3g dose in men 3 days later) or pivmecillinam 400mg TDS.