UTI in adults (no fever or flank pain)

FV Flow chart for Lower UTI in Adults

PHE URINE

Target

SIGN

CKS women

CKS men

SAPG UTI

Treat women with severe/or ≥ 3 symptoms; 

Women <65 years with mild/or ≤ 2 symptoms AND

Urine NOT cloudy 97% negative predictive value, do not treat unless other risk factors for infection. If cloudy urine use dipstick to guide treatment. Nitrite plus blood or leucocytes has 92% positive predictive value; nitrite, leucocytes, blood all negative 76% Negative Predictive Value (NPV).

Consider a back-up / delayed antibiotic option along with analgesia

Men <65 years: Consider prostatitis and send pre-treatment MSU OR if symptoms mild/non-specific, use negative dipstick to exclude UTI.

Men >65 years: Treat if fever 38⁰C or above or 1.5⁰C above base in 12 hours and > 1 other symptom.

Always safety net.

Nitrofurantoin if GFR over 45ml/min; GFR 30-45: only use if resistance & no alternative.

In treatment failure: always perform culture. 

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

Catheter in situ: antibiotics will not eradicate asymptomatic bacteriuria; only treat if systemically unwell or pyelonephritis likely. Do not use prophylactic antibiotics for catheter changes unless history of catheter-change-associated UTI or trauma (NICE). Take sample if new onset delirium, or one or more symptoms of UTI.