Collaborative Agreement Protocol for Uncomplicated Urinary Tract
Infection (females only)
Purpose:
To prescribe and provide medication to treat uncomplicated urinary tract infections for
female patients and to ensure patient receives adequate information regarding urinary
tract infections and treatment. This medication will be prescribed in a community
pharmacy by a clinical community pharmacist.
Procedure:
1. When the patient requests, or there is indication of need for treatment
for uncomplicated urinary tract infection, the clinical community pharmacist will assess
the need for treatment and/or referral to a physician for further assessment.
2. The pharmacist will refer the patient to a physician or other healthcare
provider if the use of treatment for uncomplicated urinary tract infection may not be
appropriate for the patient or if the following conditions are present: fever, flank pain,
shaking chills, nausea and vomiting.
3. In addition to the medication, patients will be provided with both verbal
and written information on the signs and symptoms of urinary tract infections, and follow
up instructions for after the use of antibiotics for uncomplicated urinary tract infection.
The patient will also be instructed to have oral phenazopyridine tablets available for use.
4. Each prescription prescribed by the clinical community pharmacist will
be documented in a patient profile as required by law. The completed patient screening
form will also be kept on file. Patient’s primary care physician will be notified.
Drug Therapy Information:
Ciprofloxacin 500mg #6
Take one tablet twice daily for three days OR
Nitrofurantoin (macrocrystals) 100mg #14
Take one capsule twice daily for seven days
Phenazopyridine 200mg #6
Take one tablet three times daily for two days OR
Phenazopyridine 95mg (or 97.5mg or 100mg) #12 (or OTC trade size)
Take two tablets three times daily for two days
Uncomplicated Urinary Tract Infection
For treatment of urinary tract infection in women that occurs without underlying abnormality
or impairment of urine flow. Most common in young women but can also occur in younger
men after unprotected intercourse. This protocol applies only to women. Men with
symptoms should be referred to medical care practitioner.
Assess
Are fever or chills present?
Is flank pain present?
Are nausea, vomiting, and rigid abdomen present?
Is there an impairment of urine flow?
Is patient pregnant?
Any “yes” answer to the above questions would be reason to recommend patient see
medical care practitioner.
Does patient have a previous history of UTI? When was last occurrence?
Are symptoms (Dysuria, sudden onset, frequency, urgency, burning or painful voiding of
small volume of urine) similar to previous UTI?
Drug Therapy Information
Ciprofloxacin 500mg #6
One tablet twice daily for 3 days.
OR
Nitrofurantoin (macrocrystals) 100mg #14
One capsule twice daily for 7 days.
CONTINUED BELOW
And if wanted
Phenazopyridine 200mg #6
One tablet three times daily for 2 days.
Or
Phenazopyridine 100mg or OTC trade size (97.2mg) two tablets up to three times daily
for two days.
Phenazopyridine WILL discolor the urine
Instructions to Patient
Contact medical care practitioner if symptoms not entirely resolved in 3 days or if fever
occurs within 3 days.
Drink at least 64 ounces of water in each 24 hour period. Drinking cranberry juice may
also be of benefit.
For women experiencing UTI after sexual intercourse, bladder voiding immediately after
intercourse and avoiding use of a diaphragm may be helpful.
Some antibiotics may interfere with the effectiveness of oral contraceptives, so alternate
means of contraception should be used.