Catheter Associated Urinary Tract Infection ( CA-UTI ) in Primary Care

Publication: 30/09/2010  --
Last review: 08/05/2017  
Next review: 30/04/2020  
Clinical Guideline
ID: 2806 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2017  


This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

The European Medicines Agency’s Pharmacovigilance Risk Assessment Committee has recommended restricting the use of fluoroquinolone antibiotics following a review of disabling and potentially long-lasting side effects mainly involving muscles, tendons, bones and the nervous system. This includes a recommendation not to use them for mild or moderately severe infections unless other antibiotics cannot be used (MHRA advice November 2018).

Catheter Associated Urinary Tract Infection (CA-UTI) in Primary Care

CA-UTI should be diagnosed clinically. Symptoms include new/worsening of fever, rigors, new confusion, lethargy/drowsiness, flank/loin/suprapubic pain, new haematuria. If symptoms of upper UTI see Upper UTI guideline

Dipstick testing should not be used to diagnose UTI in catheterised patients

Asymptomatic patients with indwelling Catheters should not receive antibiotic treatment regardless of urine result.

Antibiotic prophylaxis is not recommended for the prevention of symptomatic CA-UTI in catheterised patients

Always send Catheter Specimens of Urine (CSU) before commencing empiric antibiotic therapy. Target therapy according to culture results and clinical progress of infection.
Previous culture results should be taken into account when considering empiric treatment. If history of Multi-Drug Resistant Organisms, call Microbiology to discuss treatment options.

Change (or remove if possible) the patients catheter with appropriate antibiotic cover when treating for CA-UTI (See Urinary Catheterisation Prophylaxis in Adults guideline).

Preferred Option

Alternative Option


Nitrofurantoin PO 50mg 6-hourly for 7 days
or Nitrofurantoin MR PO 100mg 12-hourly for 7 days

(covers 90% of UTI organisms)

Pivmecillinam electronic Medicines Compendium information on Pivmecillinam PO 400mg stat dose then 200mg 8-hourly for 7 days

[Other alternatives include Trimethoprim PO 200mg 12-hourly for 7 days

Fosfomycin : Prescribe as Monuril 3g granule sachets, 3g for 1st dose and repeat after 72 hours (dose as per LHPs )

Can be used when no other suitable alternative e.g. CrCl<45mL/min, penicillin allergy, known resistance]

Nitrofurantoin is CONTRA-INDICATED in patients with CrCl<30mL/min, and should be used with CAUTION in patients with CrCl 30-44mL/min for short courses.
Avoid in patients with suspected or known glucose-6-phosphate dehydrogenase (G-6-PD) deficiency.

Pivmecillinam is a Penicillin antibiotic: Avoid in penicillin allergy
Resistance rates to Trimethoprim are >30%. Have a low threshold to send MSU if symptoms persist.
If recently grown Pseudomonas sp. or Proteus sp. from Catheter Specimen of Urine or has symptoms of UUTI:

Ciprofloxacin electronic Medicines Compendium information on Ciprofloxacin PO 500mg 12-hourly (dose may require adjustment for renal function).

Pivmecillinam tablets may be cut/crushed and they dissolve quite well in water to administer in liquid form.

The tablet needs to be cut/crushed as near to administration as possible. If dilution of a crushed tablet is required, use of a neutral, rather than an acidic fluid, will help to minimize the bitter taste which the product has following disruption of the protective film coating.

Fosfomycin: Not recommended if Cr CL < 10ml/min. No evidence to support use in Upper UTI


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Record: 2806
Clinical condition:

Catheter-associated UTI (CA-UTI)

Target patient group:
Target professional group(s): Primary Care Doctors
Adapted from:

Evidence base

Not supplied

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

Not supplied