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