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For comprehensive details on the diagnosis of urinary tract infections please refer to the algorithms and diagnosis guidelines from Public Health England.
The Patient Urinary Tract Infection (UTI) Information leaflet has been designed to be used during consultation with women who are experiencing non complicated UTIs. It is a useful tool for clinicians to use where the clinician feels that the patient does not require an antibiotic prescription. It includes information on illness duration, self-care advice, prevention advice and advice on when to re-consult.
Asymptomatic bacteriuria in non-pregnant adults does not need to be treated, even with a positive urine dip. Treating does NOT reduce mortality, UTI rates, carriage or improve incontinence.
Note: In line with NICE CKS asymptomatic bacteriuria in pregnancy should always be confirmed with a second sample and if persisting then treated.
For mild UTI symptoms with no fever or flank pain, advise patient to drink plenty of fluids, take analgesia and only use antibiotics if symptoms do not improve after 48 hours. Consider a back-up / delayed antibiotic option
Always ensure safety netting information is given as resistance is common and patients should re-consult if symptoms remain after 48hrs or they develop systemic symptoms. Possible signs of serious infection can be found in the Public Health England UTI leaflet (Please see the Patient Urinary Tract Infection information leaflet above).
Always check past microbiology results for a history of resistance and sensitivities before prescribing empirical antimicrobial therapy and always send a urine culture in treatment failures.
If 3 or more infections in the last 12 months, or 2 in the last 6 months, then follow the recurrent UTI guidance below.
Consider chlamydia if symptoms of UTI but negative cultures.
Refer to Public Health England guidelines to decide whether antibiotic treatment is appropriate.
Diagnosis of catheter associated urinary tract infection (CA-UTI) is based on clinical signs. Asymptomatic catheterised patients with cloudy or crystalline urine, debris in urine, discomfort or bypassing of the catheter do not require treatment for infection.
Patients with indwelling urinary catheters almost invariably have abnormalities on dipstick testing including nitrite, leucocyte esterase, blood and protein. Similarly bacteriuria is present in most patients with urinary catheters. Only send a CSU if patient has symptoms of systemic infection such as fever, new onset of confusion, supra-pubic tenderness. See also local pathways on diagnosis and management of CA-UTI.
When a sample for culture is indicated, include clinical details.
Urinary catheters which have been inserted for more than one week should be replaced during the course of antibiotics, if there is a clinically important UTI.
Antibiotic prophylaxis can be considered when catheters are changed if there is current infection, or a history of UTI associated with catheter change. Consider, 80mg IM gentamicin just prior to catheterisation.
Always send MSU for culture and start antibiotics. Quinolones achieve higher prostate levels.
4 weeks treatment may prevent chronic prostatitis. Review treatment after 14 days and consider accuracy of original diagnosis if no improvement.
For more information on drugs in pregnancy refer to the UKTIS maternal exposure summary documents
Take an MSU for culture & sensitivities. Immediately start antibiotics then review when results are known.
Test urine culture 7 days after completion to confirm cure. In cases of asymptomatic bacteruria in pregnancy: two positive samples are required before treatment is initiated.
Refer to NICE CG54: Urinary tract infection in under 16s: diagnosis and management (August 2007) for further information
Child younger than 3 months: refer urgently for assessment. Refer any child with features of upper UTI / pyelonephritis.
Child 3 months or older: use positive nitrite to start antibiotics. Send pre-treatment MSU for all.
Imaging: only refer if child under 6 months old, recurrent or atypical UTI
An MSU must be sent and then empirical treatment initiated. Be guided by previous MSUs (if available) for evidence of resistance.
Review treatment choices when antibiotic results available.
Depending on severity / systemic symptoms consider referral to hospital. Also, if no response within 24 hours consider referral.
Sensitivity testing performed by laboratories reflects and supports local antibiotic guidance.
A recurrent urinary tract infection is where a woman has 3 or more infections in 12 months (or 2 in 6 months).
Recurrent urinary tract infections require investigation, always send an MSU to guide treatment, and check previous cultures.
Nightly prophylaxis reduces UTIs but adverse effects and long term compliance is poor.
To reduce recurrence, first advise simple measures including hydration, analgesia, cranberry products, and then standby or post-coital antibiotics. Some self-care medicines are available in shops and supermarkets. Please click here for further information and a patient leaflet.
In North Devon, patients with recurrent UTI can be referred to a joint urology / microbiology clinic
Standby antibiotics (as per UTI in adults treatment above).
Patients should be given standby antibiotics based on previous culture results where possible. They should be told to start these antibiotics as soon as they develop symptoms, and to continue until symptoms resolve, or for up to 5 days. If they are not feeling better within 48 hours, or if they have residual symptoms after 5 days, they should be told to return. Patients should be given red top tubes so that they can take a urine culture before the first dose of antibiotics. This is used to define the epidemiology, and to guide treatment in the case of subsequent failure.