Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Urinary tract infection (lower) - women - Management
How should I manage a woman with suspected cystitis?

  • Convey a positive approach and reassure the woman that cystitis is generally self-limiting.
    • Without antibiotics, symptoms can be expected to resolve in 4–9 days.
    • With antibiotics, symptoms can be expected to resolve in 3–8 days.
    • On average, antibiotics shorten the duration of symptoms by about a day.
  • Relieve symptoms with paracetamol or ibuprofen — do not recommend urine alkalinizing agents or cranberry products.
  • If cystitis symptoms are moderate or severe:
    • Offer an antibiotic.
      • Do not dipstick test the urine, as the decision to offer an antibiotic is not influenced by urine dipstick test results. Even if the tests for nitrite, and leucocyte esterase, and blood are all negative, an antibiotic should still be offered.
    • If the woman prefers not to take an antibiotic, offer a delayed antibiotic prescription to be dispensed if the symptoms become worse, or last more than 48 hours.
  • If cystitis symptoms are mild:
    • Dipstick test the urine to guide treatment decisions.
    • Discuss not using an antibiotic, especially if the urine dipstick test is negative for nitrites and leucocyte esterase and blood.
    • Have a lower threshold for offering an antibiotic if there are risk factors for persistent infection, recurrent infection, or treatment failure.
    • If there are concerns about not taking an antibiotic, offer a delayed antibiotic prescription to be dispensed if the symptoms become worse, or last more than 48 hours.
  • Advise the woman to seek medical attention if she develops a high fever or becomes systemically unwell.

In depth

© NHS Institute for Innovation and Improvement