General Principles of management of UTI in adults (no fever or flank pain) (1)
Guidance for management of UTI in an non-pregnant woman (2)
Choice of antibiotic: non-pregnant women aged 16 years and over (2)
For a first-choice antibiotic prescribe nitrofurantoin 100 mg modified-release twice a day for 3 days if estimated glomerular filtration rate (eGFR) ≥45 mL/minute. This is effective against Escherichia coli, the most common causative pathogen in uncomplicated UTIs (70%-95% of patients) with only 0.9% resistance. (3)
Trimethoprim 200 mg twice a day for 3 days may be used if there is a low risk of resistance. This risk is lower if not used in the previous 3 months, if previous urine culture suggests susceptibility (but trimethoprim was not prescribed), and in younger people where local data suggest resistance is low. (2) A higher risk of resistance is more likely with recent use and in older patients in residential facilities. (2)
For a second-choice antibiotic, where patients have shown no improvement in lower UTI symptoms after taking a first-choice antibiotic for at least 48 hours or if the first choice is not suitable, prescribe (2) nitrofurantoin (if eGFR ≥45 mL/minute and not used as a first choice) 100 mg modified-release twice a day for 3 days, pivmecillinam 400 mg initial dose, then 200 mg three times a day for a total of 3 days, or fosfomycin 3 g single dose sachet.
(Check BNF for use and dosing in specific populations, for example, hepatic impairment, renal impairment and breast-feeding.)
Risk factors for increased resistance include:
More extensive details of drug treatment are provided in the BNF.
Indwelling catheters always seem to result in white cells and bacteria which are very difficult to get rid of. Usually they are asymptomatic, and are only to be treated with the development of symptoms.
Reference:
1. Public Health England (June 2021). Managing common infections: guidance for primary care
2. Scottish Intercollegiate Guidelines Network. Management of suspected bacterial lower urinary tract infection in adult women. Sep 2020
3. Sanchez GV, Babiker A, Master RN, et al. Antibiotic resistance among urinary isolates from female outpatients in the United States in 2003 and 2012. Antimicrob Agents Chemother. 2016 May;60(5):2680-3.
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