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Urinary tract infection (lower) - women - Management
How should I manage a woman whose cystitis has failed to respond to antibiotics?

  • Continue symptomatic treatment with paracetamol or ibuprofen.
  • Check compliance with antibiotic treatment.
  • Send a urine sample for culture.
  • If symptoms are troublesome, offer a different antibiotic (nitrofurantoin or trimethoprim) while waiting for the culture results — see Choice of antibiotic.
  • If infection is confirmed on culture, treat with an antibiotic to which the organism is sensitive.
  • If infection is not confirmed on culture, consider other possible causes for the symptoms — see Differential diagnosis.
  • If cystitis symptoms fail to respond to two courses of antibiotic shown by culture to be appropriate treatment, refer for specialist assessment.
Basis for recommendation

These recommendations are in line with guidance from the Scottish Intercollegiate Guidelines Network [SIGN, 2006].

  • The recommendation to offer a different antibiotic if symptoms persist is supported by a study of the course of uncomplicated community-acquired urinary tract infection in women [McNulty et al, 2006]. The study found that, after 5 days of antibiotic treatment, symptoms had resolved in 70% of women infected with an organism sensitive to the antibiotic, and 24% of women with a resistant isolate. The study also found that 50% of those who reconsulted in the first week had a resistant isolate.

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