What are the key differences in the management of uncomplicated versus complicated UTIs in primary care?

Key differences in management of uncomplicated versus complicated urinary tract infections (UTIs) in primary care:

• Uncomplicated UTI: Typically occurs in otherwise healthy women without structural or functional urinary tract abnormalities. Management often involves symptomatic advice and first-line oral antibiotics such as nitrofurantoin or trimethoprim for 3 days, considering local resistance patterns and patient factors. Self-care measures including hydration and analgesia are advised. Urine culture is not routinely required unless symptoms worsen or do not improve within 48 hours. Delayed antibiotic prescribing may be considered if symptoms are mild and no risk factors for complications exist ¹.
• Complicated UTI: Includes UTIs with risk factors such as pregnancy, catheter use, recurrent infections, structural or functional abnormalities, or systemic symptoms suggesting upper UTI or sepsis. Management requires urgent assessment, often hospital admission if severe systemic symptoms or inability to tolerate oral treatment occur. Urine culture and susceptibility testing are essential to guide antibiotic choice. Antibiotic courses are longer (e.g., 7 days in pregnancy) and may involve second-line agents or specialist advice. Catheter care and removal are important considerations. Patients must be advised to seek urgent review if symptoms worsen or fail to improve within 48 hours ¹.