Uncomplicated Lower Urinary Tract Infection

Clinical features

• Dysuria
• Frequency
• Suprapubic pain
• Urgency
• Polyuria
• Nocturia
• Visible haematuria
• New/worse incontinence
• New change in behaviour i.e. patient unable to feed themself or wash hands and face

Dipstick findings with no clinical features of UTI are not diagnostic and are not an indication to start treatment or to culture urine

Do not use dipsticks for women > 65 or for men

Investigation

• Urine culture if indicated
• In symptomatic patients under the age of 30, consider gonorrhoea and chlamydia (e.g. itch, discharge)

Infection Control

Basic universal precautions

Treatment

NITROFURANTOIN MR PO 100mg 12 hourly or NITROFURANTOIN IR PO 50mg 6 hourly

OR

TRIMETHOPRIM PO 200mg 12 hourly

Avoid trimethoprim in pregnancy

If oral therapy is not possible, treat as for urinary sepsis

Avoid nitrofurantoin if eGFR is <45. Seek Microbiology advice if no suitable oral option can be prescribed from those reported

Monitor elderly patients prescribed trimethoprim for evidence of renal impairment and hyperkalaemia

Duration:  3-5 days (women); 7 days (men)

In women, 3 days will treat symptoms for most; 5 days may be appropriate in selected cases where bacterial eradication is considered important, weighed against increased risk of adverse drug effects