Executive summary
- Women (Non-pregnant): Treat empirically if ≥3 symptoms (dysuria, urgency, frequency) present. Dipstick NOT required if symptoms clear (Age <65).
- Men: Always consider prostatitis/STI. Course length is 7 days. Refer Urologically if recurrent or haematuria.
- Children (>3m): Dipstick is mandatory. If positive (Leuc+Nitrite), send MSU and treat.
Treatment Choices (Adults)
- First Line (Women - 3 days):
- Nitrofurantoin: 100mg MR bd (or 50mg qds) for 3 days. (Avoid if eGFR <45).
- Trimethoprim: 200mg bd for 3 days. (Avoid if local resistance high or used in last 3 months).
- First Line (Men - 7 days):
- Trimethoprim: 200mg bd for 7 days.
- Nitrofurantoin: 100mg MR bd for 7 days.
- Pregnancy (7 days + MSU mandatory):
- Nitrofurantoin: Avoid at term (haemolysis risk).
- Amoxicillin/Cefalexin: Based on sensitivities. Avoid Trimethoprim in 1st Trimester (folate antagonist).
Red Flags (Pyelonephritis)
- Symptoms: Flank pain, fever (>38°C), rigors, nausea/vomiting.
- Action: If septic -> Admit. If well -> Cefalexin 500mg tds or Co-amoxiclav 625mg tds for 7-10 days. (Ciprofloxacin 500mg bd is alternative if non-pregnant).
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.