Urinary Tract Infections (adult): Empirical Treatment Clinical Guideline
Version 2.2 approved 27 September 2023
The Urinary Tract Infections (adult): Empirical Treatment Clinical Guideline (PDF 520KB) has been developed by the South Australian expert Advisory Group on Antimicrobial Resistance (SAAGAR) to assist clinicians in identifying and initiating empirical antimicrobial therapy for suspected bacterial urinary tract infections (UTI) in adult patients. The guideline includes advice on asymptomatic bacteriuria, recurrent UTI, catheter-associated UTI and pyelonephritis.
Key stewardship points
- Screening for, and treatment of, asymptomatic bacteriuria in older people is not recommended.
- Do not investigate or treat cloudy or malodourous urine in aged-care facility residents who do not have other clinical signs or symptoms of UTI.
- Prescribe only the number of days required to complete the shortest course (3-5 days for uncomplicated cystitis). Prolonged and often unnecessary use of antimicrobials is associated with increased side effects and the potential for driving resistance.
- Avoid use of norfloxacin or ciprofloxacin when other antibiotic choices are available as there is rising quinolone resistance in Gram negative bacteria. These antibiotics are the only oral antibiotics available to treat Pseudomonas aeruginosa.
- Do not use fosfomycin for uncomplicated UTIs. Fosfomycin is a last-line broad-spectrum antibiotic reserved for UTIs resistant to other agents.