In a 25-year-old woman with persistent urinary symptoms after 3 days of

Reassess her clinically now rather than automatically prescribing another antibiotic. Persistent symptoms after 48 hours of treatment warrant consideration of an alternative diagnosis or complication, with management directed accordingly. NICE CKS

Review the reported negative culture result and whether the sample was obtained before antibiotics; if culture and sensitivities have not already been sent, obtain a urine sample, and consider further antibiotic treatment only while awaiting results where clinically appropriate. NICE CKS

Assess for red flags requiring urgent admission, including severe systemic features suggesting pyelonephritis or sepsis, and undertake an appropriate alternative-diagnosis assessment including sexual history, pregnancy testing, vital signs, abdominal examination and, if indicated, vulval/pelvic examination. NICE CKS