Suspected of urinary tract infection:

Frequency, dysuria, hematuria, suprapubic pain, urgency, polyuria

Uncomplicated UTI Risk factors for complicated UTI:

Immunosuppressed
Poorly controlled diabetes mellitus
Post-menopausal
Perform urinalysis Urinary tract obstruction
Urolithiasis
UTI in men
CKD
Urinary catheter in situ
Nit –ve Nit –ve Neurogenic bladder
Nit +ve Recurrent UTI
Leu +ve Leu –ve

Probable UTI Unlikely UTI Perform urinalysis and urine culture

Treat with Consider other dx
antibiotics e.g. vaginitis

Assess for presence of pyelonephritis:

High grade fever, nausea / vomiting, flank pain,
UTI or other dx equally likely
leukocytosis, costovertebrae tenderness
Review technique and time of
specimen (morning most reliable)
Yes No

Treat with
Refer hospital
antibiotics
Severe symptoms Non-severe sx
(patient has ≥ 3 (patient has < 3
symptoms symptoms
suggestive of UTI) suggestive of UTI) Antibiotics Dosing Duration Remarks
Cephalexin 500mg bd 7 days Preferred
Augmentin 625mg tds 7 days Alternative
Send urine culture
Treat with and consider
antibiotics delayed antibiotic TCA to review symptoms and
prescription culture

Antibiotics Dosing Duration Remarks

Nitrofurantoin* 50-100mg qid 5 days Preferred
Cephalexin 500mg bd 3-5 days Preferred
Augmentin 625mg tds 3-5 days Alternative
Cefuroxime 250mg bd 3-5 days Alternative

1. Malaysian National Antibiotics Guideline 2018.

2. Management and treatment of common infection. Antibiotics guidance for primary care: For consultation and local
adaptation. Public Health England 2017.

* Nitrofurantion is contraindicated when eGFR is <30 ml/min