Uncomplicated urinary tract infection in womenBMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n725 (Published 30 March 2021) Cite this as: BMJ 2021;372:n725
- Tammy C Hoffmann, professor of clinical epidemiology1,
- Mina Bakhit, postdoctoral research fellow1,
- Chris Del Mar, professor of public health and general practitioner1
- 1Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia 4229
- Correspondence to: T C Hoffmann
What you need to know
In about a third of women with an uncomplicated urinary tract infection, the infection may resolve by about 7-10 days without the need for antibiotics
The option of “wait and see” (which typically involves providing a delayed prescription) can be discussed as part of a shared decision making process within the consultation
Although the risk from delaying antibiotics is low, consider pyelonephritis or sepsis in patients who are systemically unwell and have high fever, rigours, nausea/vomiting, flank pain, low blood pressure, high heart rate, high respiratory rate, not passing urine for 12-18 hours, and behaviour change
A 32 year old woman presents with suspected urinary tract infection (UTI). She is passing urine more frequently and has suprapubic pain and dysuria. After two days, her symptoms have not improved.
This article outlines how to identify uncomplicated UTI in adult non-pregnant women (18-65 years old) and discuss options with women to help them make an informed decision about its management.
What you should cover
Acute UTIs are common community infections. They affect most women at least once in their life and are far less prevalent among men.123 Women with an acute UTI present with diverse symptoms that can be burdensome and adversely affect their quality of life.45
Take a history to differentiate between an uncomplicated UTI and other causes of urinary symptoms. Recurrent UTI (≥3 UTIs within a year), asymptomatic bacteriuria, and infection associated with an indwelling urinary catheter each require a different approach, not covered here. Diagnostic studies support the diagnostic value of commonly recognised symptoms such as dysuria, haematuria, nocturia, urgency, and frequency, as well as those that reduce the probability that a patient has a UTI,67 and table 1 lists the likelihood ratios of these symptoms. In particular, the presence of two or three of the …