Management options
Management options
Having established that a UTI is the most likely cause of symptoms, the next decision is to consider whether to suggest use of an antibiotic. If symptoms are mild, then it is reasonable to discuss pain relief and self-care advice with the patient. Offer paracetamol (or ibuprofen if preferred and suitable) for up to two days.
NICE advice is to encourage intake of enough fluids to avoid dehydration but not to recommend cranberry products (although they may have a role in prevention) or urine alkalinising agents for symptoms.
In cases of uncomplicated UTIs in women who have all of the three key features (dysuria, new nocturia and cloudy urine), it is no longer routine to send urine for culture and antibiotics are used empirically. The PGD for pharmacists is to use nitrofurantoin. There may be a local policy in line with regional sensitivity data, which in some areas may recommend trimethoprim – so this should be consulted if this is the case.
Acute, uncomplicated UTIs usually resolve within a few days with or without antibiotic treatment. The duration of a UTI treated with an antibiotic to which the pathogen is sensitive is around 1.5 days shorter than when not treated with an antibiotic (3.3 days vs 4.9 days). If symptoms have not subsided within two days of beginning treatment, or have become worse, the patient should see their GP.
In addition to antibiotic treatment, it is important to offer advice about fluid intake. For women in whom cystitis is a recurrent problem, self-help measures can sometimes prevent recurrence. Signposting to relevant lifestyle information is useful.
Potassium and sodium citrate
Potassium and sodium citrate work by making the urine alkaline and have traditionally been used for cystitis. The acidic urine produced as a result of bacterial infection is thought to be responsible for dysuria. Alkalinisation of the urine may help to relieve discomfort, although there is no strong evidence of its benefit. In the absence of evidence of effectiveness, NICE Clinical Knowledge Summaries (CKS) advises against recommending urine-alkalinising agents.
Patients may have used these preparations before and may wish to purchase them. Anyone taking potassium-sparing diuretics, aldosterone antagonists or angiotensin-converting enzyme inhibitors should not use potassium citrate because it may cause hyperkalaemia. Sodium citrate should not be recommended for hypertensive patients, anyone with heart disease or pregnant women.