The Oakwood Surgery
Clinical Protocols
Lower Urinary Tract Infections
Author
Created
Reviewed
Review Date
Dr Dean Eggitt
October 2012
June 2014 (Dr Eggitt)
June 2015
Background
Urinary tract infections are very common, especially in women and the elderly. They
are less common in children and are unusual in young men. They are usually minor
infections but can cause severe sepsis if left untreated. Most lower UTIs can be
safely treated empirically with antibiotics. It may be necessary to confirm the
diagnosis with a MSU which can be sent for MCS to help understand which antibiotic
to use.
Haematuria on dipstick should be confirmed by MCS. This should be checked again
by MCS 1 week after appropriate antibiotic treatment in all men and post menopausal
women. Presence of blood on MCS after treatment should trigger an urgent GP
review
Women
Due to the urethra being close to the bladder in women, lower urinary tract infections
are common. This is especially so after the menopause due to lower oestrogen causes
atrophy of the vagina and a change in vaginal pH. Lower urinary tract infections can
therefore be treated with a short course of antibiotics. Upper urinary tract infections
with suggestions of flank pain or systemic illness are more serious and require a full
course of antibiotics.
< 65
1st Line
2nd line
Trimethoprim
Nitrofurantoin
200mg BD
100mg MR BD
3/7
3/7
(Not if CKD 3 or above)
Pregnant
1st line
2nd line
Amoxicillin
Nitrofurantoin
250mg TDS
100mg MR BD
7/7
7/7
(Not if > 27/40 pregnant)
> 65
1st line
Trimethoprim
200mg BD
5/7
Refer if
 Urological cancer is suspected
 The patient fails to respond to two courses of antibiotic treatment for
the same infection when using antibiotics shown to be appropriate by
laboratory proven sensitivities.
Men
It is unusual for young men to get urinary tract infections. Consequently, urine
infections in young men (under the age of 50) should be confirmed with a mid stream
urine sample sent to the labs and causes of infections should be considered, especially
sexually transmitted diseases.
As men age, they are more likely to get urinary tract infections. They are more
common over the age of 50 years and in those who are catheterised.
Men should always receive a “full” course of antibiotics.
1st Line
2nd line
Trimethoprim
Nitrofurantoin
200mg BD
100mg MR BD
7/7
7/7
Men DO NOT routinely need to be referred to urology because of a urinary tract
infection.
Refer if
 Failure to respond to antibiotic treatment
 Men with an underlying cause of uti – such as bladder outflow
obstruction
 Frequent episodes of UTI (defined as 2 or more in a 3 month period)
 Men under the age of 50
 Pyelonephritis, renal calculi or previous renal surgery
Children
Treatment of a UTI in children is more complex and antibiotics should be used
cautiously and where possible antibiotic choice should be guided by the results of
urine culture and sensitivities. Children with lower urinary tract symptoms and no
systemic illness can be managed safely by a minor illness nurse, whereas all other
children should be managed by a doctor.
Under 3 months of age
Should be admitted the same day for urgent treatment
3 months – 16 years
 If features of an uncomplicated lower urinary tract infection, then treat with
empirical antibiotics and confirm the diagnosis with a urine sample

Admit if uti symptoms and high risk for complications
Features of an upper urinary tract infection
High fever (> 38)
Flank pain
System malaise
Systemic malaise, vomiting, not tolerating fluids
Poor urine output
Recurring pyrexia of unknown origin
Family history of renal disease
Enlarged bladder
Abdominal mass
Children (urine should always be sent for MCS)
3 – 16 years
1st line
2nd line
Trimethoprim
Nitrofurantoin
dose as per BNF
dose as per BNF
3/7
3/7