Local adaption for Gloucestershire March 2020 vs1 Urinary Tract Infections Mar 2020 v1 https://www.nice.org.uk/about/what-we-do/our- programmes/nice-guidance/antimicrobial-prescribing- guidelines
Doses Visual Infection Key points Medicine Length Adult Child summary Urinary tract infections Lower urinary Advise paracetamol or ibuprofen for pain. Non-pregnant women first 100mg m/r BD (or tract infection choice: if unavailable 50mg Non-pregnant women: back up antibiotic (to - use if no improvement in 48 hours or symptoms nitrofurantoin (if eGFR QDS) ≥45 ml/minute) OR 3 days worsen at any time) or immediate antibiotic. trimethoprim (if low risk of 200mg BD Pregnant women, men, children or young - people: immediate antibiotic. resistance)
When considering antibiotics, take account of Non-pregnant women 100mg m/r BD (or second choice: if unavailable 50mg severity of symptoms, risk of complications, - 3 days Public Health previous urine culture and susceptibility results, nitrofurantoin (if eGFR QDS) England previous antibiotic use which may have led to ≥45 ml/minute) OR resistant bacteria and local antimicrobial pivmecillinam (a penicillin) 400mg initial dose, - 3 days resistance data. OR then 200mg TDS Last updated: If people have symptoms of pyelonephritis (such fosfomycin 3g single dose - single dose Oct 2018 as fever) or a complicated UTI, see acute sachet pyelonephritis (upper urinary tract infection) for Pregnant women first 100mg m/r BD (or antibiotic choices. choice: nitrofurantoin if unavailable 50mg - 7 days For detailed information click on the visual summary. (avoid at term) – if eGFR QDS) See also the NICE guideline on urinary tract infection ≥45 ml/minute in under 16s: diagnosis and management and the Public Health England urinary tract infection: Pregnant women second 500mg TDS
diagnostic tools for primary care. choice: amoxicillin (only if - 7 days culture results available and susceptible) OR
Page 1 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary cefalexin 500mg BD - Lower urinary Treatment of asymptomatic bacteriuria in pregnant women: choose tract infection from nitrofurantoin (avoid at term), amoxicillin or cefalexin based on recent (continued) culture and susceptibility results Men first choice: 200mg BD - trimethoprim OR nitrofurantoin (if eGFR 100mg m/r BD (or 7 days ≥45 ml/minute) if unavailable 50mg - QDS) Men second choice: consider alternative diagnoses basing antibiotic choice on recent culture and susceptibility results Children and young - people (3 months and over) first choice: trimethoprim (if low risk of resistance) OR nitrofurantoin (if eGFR - ≥45 ml/minute) Children and young - people (3 months and - over) second choice: nitrofurantoin (if eGFR ≥45 ml/minute and not used as first choice) OR amoxicillin (only if culture - results available and susceptible) OR cefalexin -
Page 2 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary Acute Advise paracetamol (+/- low-dose weak opioid) First choice (guided by 500mg BD prostatitis for pain, or ibuprofen if preferred and suitable. susceptibilities when Offer antibiotic. available): - ciprofloxacin (consider Review antibiotic treatment after 14 days and safety issues) OR either stop antibiotics or continue for a further 14 days 14 days if needed (based on assessment of ofloxacin (consider safety 200mg BD - then review history, symptoms, clinical examination, urine issues) OR
and blood tests). trimethoprim (if 200mg BD Public Health fluoroquinolone not For detailed information click on the visual - England appropriate; seek specialist summary. advice) Second choice (after 500mg OD discussion with specialist): Last updated: - levofloxacin (consider 14 days, Oct 2018 safety issues) OR then review co-trimoxazole 960mg BD - IV antibiotics (click on visual summary)
Page 3 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary Acute Advise paracetamol (+/- low-dose weak opioid) Non-pregnant women 500mg BD or TDS pyelonephritis for pain for people over 12. and men first choice: (up to 1g to 1.5g - 7 to 10 days (upper urinary Offer an antibiotic. cefalexin OR TDS or QDS for tract) severe infections) When prescribing antibiotics, take account of severity of symptoms, risk of complications, co-amoxiclav (only if 500/125mg TDS previous urine culture and susceptibility results, culture results available - 7 to 10 days previous antibiotic use which may have led to and susceptible) OR resistant bacteria and local antimicrobial trimethoprim (only if culture 200mg BD resistance data. results available and - 14 days Public Health Avoid antibiotics that don’t achieve adequate susceptible) OR England levels in renal tissue, such as nitrofurantoin. ciprofloxacin (consider 500mg BD - 7 days For detailed information click on the visual summary. safety issues) See also the NICE guideline on urinary tract infection Non-pregnant women and men IV antibiotics (click on visual summary) Last updated: in under 16s: diagnosis and management and the Oct 2018 Public Health England urinary tract infection: Pregnant women first 500mg BD or TDS diagnostic tools for primary care. choice: (up to 1g to 1.5g - 7 to 10 days cefalexin TDS or QDS for severe infections) Pregnant women second choice or IV antibiotics (click on visual summary) Children and young - people (3 months and over) first choice: cefalexin OR -
co-amoxiclav (only if - culture results available and susceptible) Children and young people (3 months and over) IV antibiotics (click on visual summary)
Page 4 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary Recurrent First advise about behavioural and personal First choice antibiotic 200mg single dose urinary tract hygiene measures, and self-care (with D- prophylaxis: trimethoprim when exposed to a - infection mannose or cranberry products) to reduce the (avoid in pregnancy) OR trigger or risk of UTI. 100mg at night For postmenopausal women, if no improvement, nitrofurantoin (avoid at 100mg single dose consider vaginal oestrogen (review within term) - if eGFR when exposed to a
12 months). ≥45 ml/minute trigger or -
For non-pregnant women, if no improvement, 50 to 100mg at Public Health consider single-dose antibiotic prophylaxis for night England exposure to a trigger (review within 6 months). Second choice antibiotic 500mg single dose prophylaxis: when exposed to a For non-pregnant women (if no improvement or - Last updated Oct no identifiable trigger) or with specialist advice for amoxicillin OR trigger or 2018 pregnant women, men, children or young people, 250mg at night consider a trial of daily antibiotic prophylaxis cefalexin 500mg single dose (review within 6 months). when exposed to a For detailed information click on the visual trigger or summary. See also the NICE guideline on urinary 125mg at night tract infection in under 16s: diagnosis and - management and the Public Health England urinary tract infection: diagnostic tools for primary care.
Page 5 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary Catheter- Antibiotic treatment is not routinely needed for Non-pregnant women 100mg m/r BD (or associated asymptomatic bacteriuria in people with a urinary and men first choice if no if unavailable 50mg urinary tract catheter. upper UTI symptoms: QDS) - infection Consider removing or, if not possible, changing nitrofurantoin (if eGFR ≥45 the catheter if it has been in place for more than ml/minute) OR 7 days 7 days. But do not delay antibiotic treatment. trimethoprim (if low risk of 200mg BD - Advise paracetamol for pain. resistance) OR amoxicillin (only if culture 500mg TDS Advise drinking enough fluids to avoid dehydration. results available and - susceptible) Offer an antibiotic for a symptomatic infection. Public Health When prescribing antibiotics, take account of Non-pregnant women 400mg initial dose, England severity of symptoms, risk of complications, and men second choice then 200mg TDS if no upper UTI - 7 days previous urine culture and susceptibility results, previous antibiotic use which may have led to symptoms:
resistant bacteria and local antimicrobial pivmecillinam (a penicillin) Last updated: Non-pregnant women 500mg BD or TDS Nov 2018 resistance data. and men first choice if (up to 1g to 1.5g Do not routinely offer antibiotic prophylaxis to - upper UTI symptoms: TDS or QDS for people with a short-term or long-term catheter. cefalexin OR severe infections) 7 to 10 days For detailed information click on the visual summary. See also the Public Health England urinary tract co-amoxiclav (only if 500/125mg TDS infection: diagnostic tools for primary care. culture results available -
and susceptible) OR
trimethoprim (only if culture 200mg BD results available and - 14 days susceptible) OR ciprofloxacin (consider 500mg BD - 7 days safety issues) Non-pregnant women and men IV antibiotics (click on visual summary) Pregnant women first 500mg BD or TDS choice: (up to 1g to 1.5g - 7 to 10 days cefalexin TDS or QDS for severe infections)
Page 6 of 7
Urinary Tract Infections Mar 2020 v1
Doses Visual Infection Key points Medicine Length Adult Child summary Catheter- Pregnant women second choice or IV antibiotics (click on visual associated summary) urinary tract Children and young - infection people (3 months and (continued) over) first choice: trimethoprim (if low risk of resistance) OR amoxicillin (only if culture - - results available and susceptible) OR cefalexin OR - co-amoxiclav (only if - culture results available and susceptible) Children and young people (3 months and over) IV antibiotics (click on visual summary)
Page 7 of 7