22nd May 2024

Lower UTI

Lower UTI (cystitis) is a bladder infection usually caused by bacteria travelling up to the urethra from the gastrointestinal tract. Management involves antibiotics and symptomatic management as described in ‘Background’.

	First line	Second line (no symptomatic improvement on first line for at least 48 hours)
Non-pregnant women	Nitrofurantoin MR 100 mg BD for 3 days (use only if eGFR ≥45) OR Trimethoprim 200 mg twice a day for 3 days	Pivmecillinam (a penicillin) 400 mg initial dose, then 200 mg three times a day for a total of 3 days
Men	Nitrofurantoin MR 100 mg BD for 7 days (use only if eGFR ≥45) OR Trimethoprim 200 mg twice a day for 7 days	Consider alternative diagnoses such as pyelonephritis and prostatitis Change antibiotic to culture and sensitivity results
In pregnancy	Nitrofurantoin MR 100 mg twice a day for 7 days (avoid at term)	Cefalexin 500mg BD 7 days OR Amoxicillin 500mg TDS for 7 days if culture results show susceptibility

First line

Second line (no symptomatic improvement on first line for at least 48 hours)

Non-pregnant women

Nitrofurantoin MR 100 mg BD for 3 days (use only if eGFR ≥45)

OR Trimethoprim 200 mg twice a day for 3 days

Pivmecillinam (a penicillin) 400 mg initial dose, then 200 mg three times a day for a total of 3 days

Men

Nitrofurantoin MR 100 mg BD for 7 days (use only if eGFR ≥45)

OR Trimethoprim 200 mg twice a day for 7 days

Consider alternative diagnoses such as pyelonephritis and prostatitis

Change antibiotic to culture and sensitivity results

In pregnancy