Quality standard
Quality statement 4: Duration of antibiotic treatment for urinary tract infection
Quality statement 4: Duration of antibiotic treatment for urinary tract infection
Quality statement
Non-pregnant women with an uncomplicated lower urinary tract infection (UTI) are prescribed a 3-day course of antibiotics, and men and pregnant women with an uncomplicated lower UTI are prescribed a 7-day course of antibiotics. [new 2023]
Rationale
When a decision is made to prescribe antibiotics, the shortest course that is likely to be effective should be prescribed to reduce the risk of antimicrobial resistance and adverse effects. Short (3-day) courses of antimicrobials are sufficient for treating uncomplicated lower UTI in non-pregnant women. They also minimise the risk of adverse events and of antimicrobial resistance. People who are at higher risk of treatment failure need longer courses of treatment.
A 7-day course of antibiotics is needed to treat uncomplicated lower UTI in men and pregnant women. Men are more at risk of complications from UTIs than women due to anatomical differences and possible outflow obstruction. Pregnant women are at greater risk of harm from a UTI than non-pregnant women.
All people taking antibiotics are reassessed if symptoms worsen rapidly or significantly, or do not start to improve within 48 hours of taking the antibiotic.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Process
a) Proportion of prescriptions for antimicrobials with the clinical indication, dose and duration of treatment documented in the patient's records.
Numerator – the number in the denominator with the clinical indication, dose and duration of treatment documented in the patient's records.
Denominator – the number of prescriptions for antimicrobials.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from prescribing systems and patient records.
b) Proportion of antibiotic courses prescribed for a 3-day duration for episodes of uncomplicated lower UTI in non-pregnant women.
Numerator – the number in the denominator prescribed a 3-day course of antibiotics.
Denominator – the number of antibiotic courses prescribed for episodes of uncomplicated lower UTI in non-pregnant women.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from prescribing systems and patient records.
c) Proportion of antibiotic courses prescribed for a 7-day duration for episodes of uncomplicated lower UTI in men.
Numerator – the number in the denominator prescribed a 7-day course of antibiotics.
Denominator – the number of antibiotic courses prescribed for episodes of uncomplicated lower UTI in men.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from prescribing systems and patient records.
d) Proportion of antibiotic courses prescribed for a 7-day duration for episodes of uncomplicated lower UTI in pregnant women.
Numerator – the number in the denominator prescribed a 7-day course of antibiotics.
Denominator – the number of antibiotic courses prescribed for episodes of uncomplicated lower UTI in pregnant women.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from prescribing systems and patient records.
Outcome
Average duration of antibiotic treatment for UTI.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records and prescribing systems. OpenPrescribing.net includes the prescribing measure 'Antibiotic stewardship: three-day courses for uncomplicated UTIs', which allows comparisons between organisations.
What the quality statement means for different audiences
Service providers (such as GP practices, hospitals, pharmacies) ensure that healthcare professionals prescribing antibiotics to treat uncomplicated lower UTIs are aware that non-pregnant women should be prescribed a 3-day course of antibiotics, and men and pregnant women should be prescribed a 7-day course of antibiotics.
Healthcare professionals (such as GPs, hospital doctors and community pharmacists) prescribe a 3-day course of antimicrobials to treat uncomplicated lower UTI in non-pregnant women and a 7-day course of antibiotics to treat uncomplicated lower UTI in men and pregnant women. They give advice on possible adverse effects of the antibiotics and when to seek medical advice. They reassess if a person's symptoms worsen or do not start to improve within 48 hours of taking the antibiotic.
Integrated care systems lead on antimicrobial stewardship in their area.
Women with lower UTI who are not pregnant are prescribed a 3-day course of antibiotics. Men and pregnant women with lower UTI are prescribed a 7-day course of antibiotics.
Source guidance
Urinary tract infection (lower): antimicrobial prescribing. NICE guideline NG109 (2018), recommendations 1.1.3, 1.1.5, 1.4.1 and tables 1 to 3
Definitions of terms used in this quality statement
Uncomplicated lower UTI
An infection of the bladder, also known as cystitis. Uncomplicated means it is caused by typical pathogens in people with a normal urinary tract and kidney function, and no predisposing co-morbidities (such as immunosuppression or poorly controlled diabetes). This definition excludes UTI with an increased likelihood of complications such as persistent infection, treatment failure and recurrent infection. It also excludes cases where there are symptoms of pyelonephritis (such as fever). [NICE's clinical knowledge summary on urinary tract infection (lower) – men, background information, definition, NICE's clinical knowledge summary on urinary tract infection (lower) – women, background information, definition and NICE's guideline on urinary tract infection (lower): antimicrobial prescribing, recommendation 1.4.1 and tables 1 to 3]
Equality and diversity considerations
There are different course lengths of antibiotics recommended for men and women. For trans people, there are no specific course lengths. Prescribing for trans people should be based on anatomy and will need to take account of any gender reassignment surgery and whether there has been structural alteration of the person's urethra.