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Urinary tract infection (lower) - women - Management
How should I treat lower UTI in a woman with an indwelling catheter?

  • Do not treat asymptomatic bacteriuria.
  • Remember that considerable clinical judgement is required to diagnose urinary tract infection (UTI) in women with an indwelling urinary catheter.
  • If symptoms are severe (for example, severe nausea and vomiting, confusion, tachypnoea, tachycardia, hypotension, reduced urine output), admit to hospital as intravenous antibiotics may be required.
  • Check that the catheter is correctly positioned and not blocked.
    • If the catheter has been in place for more than a week, consider changing it before starting antibiotic treatment.
  • If there is fever, or loin pain, or both, manage as upper UTI, see the CKS topic on Pyelonephritis - acute.
  • Otherwise, treat for lower UTI:
    • Relieve symptoms with paracetamol or ibuprofen.
    • Send urine for culture and microscopy before starting antibiotic treatment.
    • Prescribe an antibiotic for 7 days, following local guidelines when available.
      • If symptoms are mild, consider withholding antibiotics until the result of urine culture is available to guide choice of antibiotic.
      • If symptoms are moderate or severe, empirically prescribe an antibiotic.
    • Follow up after 48 hours (or according to the clinical situation) to check response to treatment and the result of urine culture.

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