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ALL / Infectious Diseases
Urinary tract infection in adults: management
Urinary tract infection in adults: management
Lower urinary tract infections
Non-pregnant women
- local antibiotic guidelines should be followed if available
- NICE recommend trimethoprim or nitrofurantoin for 3 days
- send a urine culture if:
- aged > 65 years
- visible or non-visible haematuria
Pregnant women
- if the pregnant woman is symptomatic:
- a urine culture should be sent in all cases
- should be treated with an antibiotic for 7 days
- first-line: nitrofurantoin (should be avoided near term)
- second-line: amoxicillin or cefalexin
- trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy
- asymptomatic bacteriuria in pregnant women:
- a urine culture should be performed routinely at the first antenatal visit
- NICE recommend an immediate antibiotic prescription of either nitrofurantoin (should be avoided near term), amoxicillin or cefalexin. This should be a 7-day course
- the rationale of treating asymptomatic bacteriuria is the significant risk of progression to acute pyelonephritis
- a further urine culture should be sent following completion of treatment as a test of cure
- women who suffer regular urinary tract infections following sexual intercourse can be offered post-coital antibiotic prophylaxis - single dose trimethoprim or nitrofurantoin are used first-line
Men
- an immediate antibiotic prescription should be offered for 7 days
- as with non-pregnant women, trimethoprim or nitrofurantoin should be offered first-line unless prostatitis is suspected
- a urine culture should be sent in all cases before antibiotics are started
- NICE state: 'Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI).'
Catherised patients
- do not treat asymptomatic bacteria in catheterised patients
- if the patient is symptomatic they should be treated with an antibiotic
- a 7-day, rather than a 3-day course should be given
- consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days
Acute pyelonephritis
For patients with sign of acute pyelonephritis hospital admission should be considered
- local antibiotic guidelines should be followed if available
- the BNF currently recommends a broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
+PassMedicine Notes
Lower urinary tract infections
Non-pregnant women- local antibiotic guidelines should be followed if available
- NICE recommend trimethoprim or nitrofurantoin for 3 days
- send a urine culture if:
- aged > 65 years
- visible or non-visible haematuria
- if the pregnant woman is symptomatic:
- a urine culture should be sent in all cases
- should be treated with an antibiotic for 7 days
- first-line: nitrofurantoin (should be avoided near term)
- second-line: amoxicillin or cefalexin
- trimethoprim is teratogenic in the first trimester and should be avoided during pregnancy
- asymptomatic bacteriuria in pregnant women:
- a urine culture should be performed routinely at the first antenatal visit
- NICE recommend an immediate antibiotic prescription of either nitrofurantoin (should be avoided near term), amoxicillin or cefalexin. This should be a 7-day course
- the rationale of treating asymptomatic bacteriuria is the significant risk of progression to acute pyelonephritis
- a further urine culture should be sent following completion of treatment as a test of cure
- women who suffer regular urinary tract infections following sexual intercourse can be offered post-coital antibiotic prophylaxis - single dose trimethoprim or nitrofurantoin are used first-line
- an immediate antibiotic prescription should be offered for 7 days
- as with non-pregnant women, trimethoprim or nitrofurantoin should be offered first-line unless prostatitis is suspected
- a urine culture should be sent in all cases before antibiotics are started
- NICE state: 'Referral to urology is not routinely required for men who have had one uncomplicated lower urinary tract infection (UTI).'
- do not treat asymptomatic bacteria in catheterised patients
- if the patient is symptomatic they should be treated with an antibiotic
- a 7-day, rather than a 3-day course should be given
- consider removing or changing the catheter as soon as possible if it has been in place for longer than 7 days
Lower UTI management by patient group
Acute pyelonephritis
For patients with sign of acute pyelonephritis hospital admission should be considered- local antibiotic guidelines should be followed if available
- the BNF currently recommends a broad-spectrum cephalosporin or a quinolone (for non-pregnant women) for 10-14 days
