Uncomplicated UTI in non-pregnant adult women (no fever or flank pain)
Antimicrobial prescribing: NHS Grampian, Orkney & Shetland
What's new / Latest updates
Resource links and advice on when to use back-up antibiotic prescription updated.
Nitrofurantoin (second line) - added note highlighting cost difference between immediate and modified release capsules.
Assessment decision support tool for women <65 years based on SIGN 160
Decision aid for diagnosis and management for people aged ≥65 years
Either
Back-up antibiotic prescription if symptoms are mild and there are no risk factors for complicated UTI. Advise to start treatment if symptoms do not start to improve within 48 hours or symptoms worsen at any time.
Or
Immediate antibiotic prescription
Choose antibiotic based on recent urine culture susceptibilities if available, otherwise, treat empirically (see below).
Advise paracetamol or ibuprofen for pain.
Maintain adequate hydration – aim to drink 1.5L of water a day if no contraindications.
Increasing incidence of multi-resistant E coli with extended-spectrum beta-lactamase (ESBL) enzymes, so perform culture in all treatment failures.
Drug details
First Line
Trimethoprim 200mg twice daily for 3 days
Second Line
Nitrofurantoin capsules 50mg four times daily for 3 days
or
Nitrofurantoin m/r capsules 100mg twice daily for 3 days
Please note that modified-release nitrofurantoin capsules are significantly more expensive than immediate-release capsules but may be better tolerated and can be taken twice daily rather than four times daily. Overlabelled packs for nitrofurantoin are only available as modified-release capsules.