UTI in Adults (No Fever or Flank Pain)

Warning

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

Drug

Pivmecillinam (contains Penicillin)

Pivmecillinam (Mecillinam) - Information For Prescribers

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.

Editorial Information

Last reviewed: 22/03/2021

Next review date: 22/03/2024

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: AMC; ADTC

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: August 2022