UTIs—good antibiotic prescribing habits for women

Women are 50 times more likely to experience a urinary tract infection (UTI) than men. In fact, more than 30% of all women will experience a UTI during their lifetime. UTI, sometimes referred to as acute uncomplicated cystitis, is one of the most common reasons otherwise healthy, non-pregnant young women visit their doctor.


Most bacteria responsible for UTIs originate in the gut and colonise the perineum, then ascend through the urethra to infect the bladder mucosa. Globally, the most common pathogens associated with uncomplicated UTI are Escherichia coli, accounting for 80%-90% of infections and Staphylococcus saprophyticus, accounting for around 5%-10%. Proteus species and other Gram-negative rods are responsible for the remaining infections.1

Prescribing antibiotics

A number of different antimicrobials are used to treat UTIs. Therapy for uncomplicated infections is generally started before the results of microbiological tests are known, the rationale being that the spectrum of causative microbes is highly predictable.

Current guidelines recommend the following:


• In non-pregnant women
Nitrofurantoin 100 mg orally, 12-hourly for 5 days
OR
Trimethoprim 300 mg orally, daily for 3 day
OR
Cephalexin 500 mg orally, 12-hourly for 3 days
OR
Amoxycillin + clavulanate 500 mg +125 mg orally, 12-hourly for 5 days

• In pregnant women:

Nitrofurantoin 100 mg orally, 12-hourly for 5 days

OR
Cephalexin 500 mg orally, 12-hourly for 3 days
OR
Amoxycillin + clavulanate 500 mg +125 mg orally, 12-hourly for 5 days

Keep in mind that antimicrobial resistance among pathogens associated with UTIs has been increasing worldwide. Importantly nitrofurantoin doesn’t share cross-resistance with more commonly prescribed antibiotics, so its widespread use as a UTI antimicrobial agent may be justified.