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Lower UTI
Diagnose on symptoms, choose by eGFR and pregnancy, spot pyelonephritis.
Typical consult⏱ 10–15 min
Investigations🔬 Urine dip (women < 65); culture in men/pregnancy
Usual outcome💊 Nitrofurantoin 3 days (women)
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| Fever, rigors, loin pain, vomiting | Pyelonephritis — see upper UTI |
| Sepsis features | Sepsis pathway |
| Visible haematuria without infection, or persistent | Urology / 2WW (age-dependent) |
| Pregnant | 7-day course, culture, follow-up |
| Man with fever / perineal pain | Prostatitis — different antibiotics and duration |
| Catheter in situ | Catheter-associated UTI — change catheter, culture |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
Women under 65 (PHE/UKHSA diagnostic tool)
- Key symptoms: dysuria, new nocturia, cloudy urine
- 2–3 key symptoms → likely UTI, treat
- Nitrite or leucocyte + red blood cells on dip → likely UTI
- Women ≥ 65 / catheterised: don’t use urine dips — diagnose clinically, send culture
Send urine culture in men, pregnancy, recurrent, treatment failure, and age ≥ 65.
| Investigation | Only if… |
|---|---|
| Urine dip | Women under 65 with 1 or fewer key symptoms |
| Urine culture | Men, pregnancy, ≥ 65, recurrent, treatment failure, catheter |
5Treat & send home
Management & advice
- Paracetamol / ibuprofen; drink normally
- Back-up prescription option for mild symptoms in non-pregnant women
- Advice on recurrence prevention
Refer / follow-up
- Pyelonephritis / sepsis → see pyelonephritis guidance
- Recurrent UTI → GP
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Women: nitrofurantoin (eGFR ≥ 45) | 100 mg modified-release twice a day | 3 days |
| Women: trimethoprim (low resistance risk) | 200 mg twice a day | 3 days |
| Women second line: pivmecillinam | 400 mg first dose, then 200 mg three times a day | 3 days total (or fosfomycin 3 g single dose) |
| Men: trimethoprim | 200 mg twice a day | 7 days (or nitrofurantoin 100 mg MR twice a day if no prostatitis) |
| Pregnant: nitrofurantoin (eGFR ≥ 45, avoid at term) | 100 mg modified-release twice a day | 7 days; send culture |
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
6Safety-net
Say it like this
This is a bladder infection. Take the antibiotic twice a day for 3 days and drink normally. You should feel better within 2 days. If you develop a fever, shivers, pain in your back or side, or vomiting, that can mean the kidney is involved. Come back the same day or call 111.
Come back / call 111 — or 999 if severe — if:
- Fever, shivering, pain in your back or side, vomiting
- Blood in urine that doesn’t clear
- Not improving within 48 hours of antibiotics
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Lower UTI — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — LOWER UTI
PRESENTING COMPLAINT:
HISTORY
Dysuria, frequency, urgency, new nocturia, cloudy urine:
Fever, loin pain, rigors:
Vaginal discharge (consider STI / thrush):
Pregnancy, men, catheter, recurrent UTIs, recent antibiotics:
eGFR / renal function, allergies:
RED FLAGS (record present / absent)
[ ] Fever, rigors, loin pain, vomiting
[ ] Sepsis features
[ ] Visible haematuria without infection, or persistent
[ ] Pregnant
[ ] Man with fever / perineal pain
[ ] Catheter in situ
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Obs:
Renal angle / loin tenderness:
Suprapubic tenderness:
DECISION RULE — Women under 65 (PHE/UKHSA diagnostic tool): result ______
INVESTIGATIONS: none required / Urine dip, Urine culture — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Urinary tract infections (UTIs), Antibiotics — when you need them
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Fever, shivering, pain in your back or side, vomiting
- Blood in urine that doesn’t clear
- Not improving within 48 hours of antibiotics
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
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