Uncomplicated lower UTI in non-pregnant females

N.B. Do not treat asymptomatic bacteriuria or “positive” urine dipsticks in the absence of urinary symptoms. Do not send urine samples for culture in asymptomatic elderly patients, even if dipstick tests are positive.

First line (first UTI or no antimicrobials in last 6 months):

Trimethoprim oral 200mg 12 hourly

Second line:

Nitrofurantoin modified-release (M/R) oral 100mg 12 hourly

or

Nitrofurantoin oral 50-100mg 6 hourly

N.B. Avoid nitrofurantoin if eGFR <45ml/min. Nitrofurantoin does not achieve therapeutic serum or tissue levels and is only used for the treatment of uncomplicated lower UTI. It is not an appropriate agent for upper or bacteraemic UTI. Do not use as IV-to-oral switch in urosepsis.

Follow the SIGN 160 Quick Reference Guide for diagnosis.  

• Smelly or dark-coloured urine are not signs of UTI. 
• If the patient describes new onset vaginal itch and discharge, do not treat for UTI.
• Only use urinalysis to confirm a diagnosis of UTI in non-pregnant women <65 years old with 2 or more lower urinary tract symptoms. 
• Due to high prevalence of asymptomatic bacteriuria, dipstick testing is not recommended to diagnose UTI in the elderly.

Consider pyelonephritis in patients with fever, rigors or flank pain / tenderness.