UTI in Adults (no fever or flank pain)

Nitrofurantoin should be avoided in renal impairment (GFR < 45mL/min) – only use if GFR 30-45 if resistance & no alternative.

Treat women with severe/or ≥ 3 symptoms (dysuria, frequency, urgency, polyuria, haematuria, suprapubic tenderness);

women mild/or ≤ 2 symptoms – recommend pain relief and consider delayed / back-up prescription.

If urine NOT cloudy - 97% Negative Predictive Value (NPV) of no UTI.

If cloudy urine - use dipstick to guide treatment: nitrite plus blood or leucocytes has 92% positive predictive value (PPV); nitrite, leucocytes, blood all negative has 76% Negative Predictive Value.

Men: Consider prostatitis and send pre-treatment MSU OR if symptoms mild/non-specific, use negative dipstick to exclude UTI.

In treatment failure: always perform culture.


 People > 65 years: do not treat asymptomatic bacteriuria; it is common but is not associated with increased morbidity.

>65 years: treat if fever >38C or 1.5C above baseline twice in 12 hours AND dysuria OR > 2 other symptoms.

Catheter in situ: antibiotics will not eradicate asymptomatic bacteriuria; only treat if systemically unwell or pyelonephritis likely.

Antibiotic prophylaxis at catheter insertion is only indicated in patients for whom bacteriuria is associated with a high risk of sepsis, those at particular risk of infective endocarditis, patients with a history of symptomatic UTI after catheter change, or who experience trauma during catheterisation – refer to acute sector empirical antibiotic guidelines for high risk conditions and antibiotic options. (NICESIGN).


200mg twice daily

Women all ages 3 days

Men 7 days


100mg m/r twice daily

Women all ages 3 days

Men 7 days

Risk factors for increased resistance include: care home resident, recurrent UTI, hospitalisation >7d in the last 6 months, unresolving urinary symptoms, recent travel to a country with increased antimicrobial resistance (outside Northern Europe and Australasia) especially health related, previous known UTI resistant to trimethoprim, cephalosporins or quinolones.

If increased resistance risk, send culture for susceptibility testing & give safety net advice.