Clinical Notes : Urology

157. Lower UTI prescribing

Lower UTI prescribing

Managing lower urinary tract infection

Treatment for women with lower UTI who are not pregnant

Treatment for children and young people under 16 years with lower UTI

Treatment for pregnant women with lower UTI

Treatment for men with lower UTI

Advice for all people with lower UTI when an antibiotic prescription is given

Reassessment

Referral

Managing asymptomatic bacteriuria

Self-care

- References -

- CPD Quiz -

Managing lower urinary tract infection

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• Be aware that lower urinary tract infection (UTI) is an infection of the bladder usually caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder

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• Give advice about managing symptoms with self-care (see the recommendations on self-care) to all people with lower UTI

UTI (lower): antimicrobial prescribing

Treatment for women with lower UTI who are not pregnant

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• Consider a back-up antibiotic prescription (to use if symptoms do not start to improve within 48 hours or worsen at any time) or an immediate antibiotic prescription (see the recommendations on  choice of antibiotic) for women with lower UTI who are not pregnant. Take account of:

  • the severity of symptoms

  • the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract or immunosuppression

  • the evidence for back-up antibiotic prescriptions, which was only in non-pregnant women with lower UTI where immediate antibiotic treatment was not considered necessary

  • previous urine culture and susceptibility results

  • previous antibiotic use, which may have led to resistant bacteria

  • preferences of the woman for antibiotic use

• If a urine sample has been sent for culture and susceptibility testing and an antibiotic prescription has been given:

  • review the choice of antibiotic when microbiological results are available, and

  • change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving, using a narrow-spectrum antibiotic wherever possible

Choice of antibiotic: non-pregnant women aged 16 years and over

Treatment for children and young people under 16 years with lower UTI

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• Obtain a urine sample from children and young people with lower UTI before antibiotics are taken, and dipstick test or send for culture and susceptibility testing in line with the NICE guideline on urinary tract infection in under 16s

• Assess and manage children under 5 with lower UTI who present with fever as outlined in the NICE guideline on fever in under 5s

• Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) for children and young people under 16 years with lower UTI. Take account of:

  • previous urine culture and susceptibility results

  • previous antibiotic use, which may have led to resistant bacteria

• If a urine sample has been sent for culture and sensitivity testing when an antibiotic prescription has been given:

  • review the choice of antibiotic when microbiological results are available, and

  • change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not already improving, using a narrow-spectrum antibiotic wherever possible

Choice of antibiotic: children and young people under 16 years

Treatment for pregnant women with lower UTI

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• Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) to pregnant women and men with lower UTI. Take account of:

  • previous urine culture and susceptibility results

  • previous antibiotic use, which may have led to resistant bacteria

• Obtain a midstream urine sample from pregnant women and men before antibiotics are taken, and send for culture and susceptibility testing

• For pregnant women with lower UTI:

  • review the choice of antibiotic when microbiological results are available, and

  • change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow-spectrum antibiotic wherever possible

Choice of antibiotic: pregnant women aged 12 years and over

Treatment for men with lower UTI

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• Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) to pregnant women and men with lower UTI. Take account of:

  • previous urine culture and susceptibility results

  • previous antibiotic use, which may have led to resistant bacteria

• Obtain a midstream urine sample from pregnant women and men before antibiotics are taken, and send for culture and susceptibility testing

• For men with lower UTI:

  • review the choice of antibiotic when microbiological results are available, and

  • change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not already improving, using a narrow-spectrum antibiotic wherever possible

Choice of antibiotic: men aged 16 years and over

Advice for all people with lower UTI when an antibiotic prescription is given

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• When a back-up antibiotic prescription is given, as well as the general advice on self-care, give advice about:

  • an antibiotic not being needed immediately

  • using the back-up prescription if symptoms do not start to improve within 48 hours or if they worsen at any time

  • possible adverse effects of antibiotics, particularly diarrhoea and nausea

  • seeking medical help if antibiotics are taken and:

    • symptoms worsen rapidly or significantly at any time, or

    • symptoms do not start to improve within 48 hours of taking the antibiotic, or the person becomes systemically very unwell

• When an immediate antibiotic prescription is given, as well as the general advice on self-care, give advice about:

  • possible adverse effects of the antibiotic, particularly diarrhoea and nausea

  • seeking medical help if symptoms worsen rapidly or significantly at any time, do not start to improve within 48 hours of taking the antibiotic, or the person becomes systemically very unwell

Reassessment

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• Reassess if symptoms worsen rapidly or significantly at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:

  • other possible diagnoses

  • any symptoms or signs suggesting a more serious illness or condition, such as pyelonephritis

  • previous antibiotic use, which may have led to resistant bacteria

Send a urine sample for culture and susceptibility testing if this has not already been done and review treatment when results are available 

Referral

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• Refer people aged 16 years and over with lower UTI to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example, sepsis)

• Refer children or young people with lower UTI to hospital in line with the NICE guideline on urinary tract infection in under 16s

Managing asymptomatic bacteriuria

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• Be aware that asymptomatic bacteriuria:

  • is significant levels of bacteria (greater than 105 colony forming units/ml) in the urine with no symptoms of UTI

  • is not routinely screened for, or treated, in women who are not pregnant, men, young people and children

  • is routinely screened for, and treated with antibiotics, in pregnant women because it is a risk factor for pyelonephritis and premature delivery (see the recommendations on choice of antibiotic)

• Offer an immediate antibiotic prescription to pregnant women with asymptomatic bacteriuria, taking account of:

  • recent urine culture and susceptibility results

  • previous antibiotic use, which may have led to resistant bacteria

Self-care

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• Advise people with lower UTI about using paracetamol for pain, or if preferred and suitable ibuprofen

• Advise people with lower UTI about drinking enough fluids to avoid dehydration

• Be aware that no evidence was found on cranberry products or urine alkalinising agents to treat lower UTI

Diagnosis of urinary tract infections

Public Health England. 

November 2018

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Urological Infections

​EAU Urological Infections Guidelines Panel

2018

Access

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Urinary tract infection (lower): antimicrobial prescribing

National Institute for Health and Care Excellence

November 2018

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Giesen, L. G. et al.

Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs.

BMC Family Practice. 2010;11(78).

Access

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Michaels T, Sands J.

Dysuria: Evaluation and Differential Diagnosis in Adults.

American Family Physician. 2015;92(9)

Access

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Management of suspected bacterial urinary tract infection in adults.

Scottish Intercollegiate Guidelines Network (SIGN).

July 2012

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Urinary tract infections in women

BMJ Best Practice

Last updated: January  2019

Last reviewed: March 2019

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Urinary tract infections in men

BMJ Best Practice

Last updated: September 2018

Last reviewed: March 2019

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                 Republic of Ireland NOTES :

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Nitrofuradantoin is available in Ireland as Macrobid (100mg BD) and as Macrodantin (100mg QID)

Trimethoprim is available in Ireland as Monoprim, Trimoptin

Fosfomycin is available in Ireland as Monuril

Amoxicillin is available in Ireland as Amoxil, Geramox, Pinamox

Pivmecillinam is not available in Ireland

Cefalexin is not available in Ireland

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