Urinary tract infections

EBM Guidelines

Last updated: 2013-04-04 © Duodecim Medical Publications Ltd

Quick Reference [1]

Urinary tract infection in a child [2]




Differential diagnosis

Urethral syndrome

Other diseases to be taken into account

Asymptomatic bacteriuria

Cystitis in female patient

Table 1. Treatment of cystitis in a female patient
DrugDaily doseTreatment duration
Trimethoprim160 mg × 2 or 300 mg × 13 days
Nitrofurantoin75 mg × 23 days
Pivmecillinam200 mg × 3 or 400 mg × 23 days

Acute pyelonephritis

Table 2. Treatment of acute pyelonephritis
  1. When oral treatment is not feasible; after a response is seen, further treatment is carried out with an oral fluoroquinolone, a first generation cephalosporin or sulpha-trimethorprim.
  2. May be used if the strain is known to be sensitive to the drug combination or there are contraindications to fluoroquinolones.
DrugDaily doseTreatment duration
Fluoroquinolone7 days
  • Ciprofloxacin
  1. 500 mg × 2 p.o.
  • Levofloxacin
  1. 250–500 mg × 1 p.o.
  • Ofloxacin
  1. 200 mg × 2 p.o.
Cefuroxime1750–1 500 mg × 3 i.v.10 days
Sulpha-trimethoprim2160/800 mg × 2 p.o.10 days

UTI in a male patient

UTI during pregnancy

Table 3. Treatment of asymptomatic bacteriuria and cystitis during pregnancy
Nitrofurantoin 75 mg × 2
Pivmecillinam 200 mg × 3Repeated courses of mecillinam should be avoided during pregnancy, because pivmecillinam lowers the serum carnitine concentration.
First generation cephalosporinsCephalexin 500 mg × 3
Amoxicillin 500 mg × 3Can only be used if the sensitivity of the causative agent has been confirmed

UTI among residents in long-term care facilities

Recurrent UTI

Table 4. Alternatives for low-dose prophylactic medication
Trimethoprim 100 mg in the evening Methenamine hippurate 1 g × 2
Nitrofurantoin 50–75 mg in the evening Norfloxacin 200 mg × 1 or at 3 nights per week
Other fluoroquinolone
Table. Alternatives for postcoital antimicrobial prophylaxis
Trimethoprim 100–300 mg in a single doseNorfloxacin 200 mg
Nitrofurantoin 50–75 mg in a single doseOfloxacin 100 mg or ciprofloxacin 100–250 mg
Sulpha-trimethoprim (1 single-strength tablet)

UTI caused by ESBL bacteria

Further investigations

Related resources


  1. Auquer F, Cordón F, Gorina E, Caballero JC, Adalid C, Batlle J, Urinary Tract Infection Study Group. Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women. Clin Microbiol Infect 2002 Jan;8(1):50-4.
  2. Sandberg T, Skoog G, Hermansson AB et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet 2012;380(9840):484-90.
  3. Auer S, Wojna A, Hell M. Oral treatment options for ambulatory patients with urinary tract infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli. Antimicrob Agents Chemother 2010;54(9):4006-8.
  4. Rottier WC, Ammerlaan HS, Bonten MJ. Effects of confounders and intermediates on the association of bacteraemia caused by extended-spectrum ß-lactamase-producing Enterobacteriaceae and patient outcome: a meta-analysis. J Antimicrob Chemother 2012;67(6):1311-20.