pharmacy first UTI

Question 1

what red flags are important to consider here that would require immediate referral

Answer 1

NEWS2 indicating sepsis
reccurrent UTI
kidney pain
flu like illness
shaking/chills
nausea/vomiting
fever/ high temp

Question 2

what is pyelonephritis

Answer 2

Acute pyelonephritis is an infection of one or both kidneys usually caused by bacteria arising in the bladder – the most common causative pathogen is Escherichia coli, responsible for 60-80% of uncomplicated infections.

Question 3

symptoms of pylonepheritis that would require refferal

Answer 3

☐ Kidney pain/tenderness in back under ribs
☐ New/different myalgia, flu like illness
☐ Shaking chills (rigors) or temperature 37.9°C or above
☐ Nausea/vomiting

Question 4

what clinical condition does the UTI clinical pathway refer to

Answer 4

lower UTI in non-pregnant women ages 16-64 in the absence of current fever

Question 5

what three diagnostic symptoms should be assessed for

Answer 5

Dysuria (burning pain when passing urine)
New nocturia (needing to pass urine in the night)
Urine cloudy to the naked eye (visual inspection by pharmacist if practicable)

Question 6

what are some other symptoms of UTI

Answer 6

urgency, frequency, visible haematuria, suprapubic pain or tenderness

Question 7

what rescources should be given to patinets who have been treated for a UTI via pharmacy first

Answer 7

PIL of chosen drug
TARGET leaflet
safety netting
what to do if symptoms worsen or do not get better

Question 8

what other symptoms would require an onward referral

Answer 8

☐ Vaginal discharge: 80% do not have UTI (treat over the counter if
signs and symptoms of thrush)
☐ Urethritis: inflammation post sexual intercourse, irritants
☐ Check sexual history to exclude sexually transmitted infections
☐ Check for signs and symptoms of pregnancy- ask about missed or
lighter periods- carry out a pregnancy test if unsure
☐ Genitourinary syndrome of menopause (vulvovaginal atrophy)
☐ Is the patient immunosuppressed?

Question 9

if a patinet displays one key symptom of UTI what should be done

Answer 9

Refer to GP or sexual health clinic as UTI may be likely, but based on symptoms, we cannot be sure. Need a definitive diagnosis

Question 10

What is the antibiotic treatment used for the treatment of UTI via the pharmacy first

Answer 10

Nitrofurantoin

Question 11

key councelling points for Nitrofruatoin

Answer 11

take w food
DOSE AND FREQUENCY
common side effects: Nausea, vomiting, anorexia, urine discolouration
dizziness, headache

Question 12

self care advice for UTI (current)

Answer 12

drink plenty of fluids
take pain relief regularly
cranberry juice can help some women but little evidence to support their use

Question 13

can a patinet take cystitis meds such as cystopurin alongside nitrofruantoin for UTI

Answer 13

No, Cystopurin contains potassium or sodium citrate, which works by alkalinising the urine (making it less acidic).
Nitrofurantoin, however, needs an acidic environment (low pH) in the urine to work effectively. If the urine becomes more alkaline (higher pH) because of Cystopurin, nitrofurantoin becomes less effective at killing the bacteria.

So, giving Cystopurin alongside nitrofurantoin could reduce the antibiotic’s effectiveness, which could lead to treatment failure.
→ That’s why it’s contraindicated to use them together.

Question 14

what meds shouldnt be taken with nitrofruantoin

Answer 14

• antacids:
  🔹 Magnesium-containing antacids (e.g., Gaviscon Advance, Rennie Deflatine)
  → Why? They can reduce the absorption of nitrofurantoin from the gut, making it less effective.
  (Advice: Avoid taking magnesium antacids within 2 hours of nitrofurantoin.)

🔹 Potassium or sodium citrate (e.g., Cystopurin, Cymalon, Effercitrate)
→ Why? As you already know, these alkalinise the urine, reducing nitrofurantoin’s effectiveness.

🔹 Urine alkalinisers marketed for cystitis symptom relief (even some herbal ones)
→ Why? Same problem — they reduce urine acidity needed for nitrofurantoin to work.

Question 15

what can be given to the patient for pain relief

Answer 15

simple OTC pain relief - paracetamol

Question 16

what conditions flags for nitrofurantoin supply under the PGD

Answer 16

🔹 Pregnant (over 37 weeks or due for delivery) — risk of haemolytic anaemia in newborn
🔹 Breastfeeding under 1 month old baby — risk to infant
🔹 Symptoms suggest upper UTI/pylonepheritis (e.g., fever, chills, flank pain) — needs referral
🔹 Recurrent UTIs (≥2 episodes in last 6 months or ≥3 in last 12 months) — needs GP review
🔹 Signs of systemic infection — feeling very unwell, vomiting, severe dehydration, conduct NEWS2
🔹 Known kidney problems or eGFR <45 mL/min — nitrofurantoin won’t work properly
🔹 Allergy to nitrofurantoin or other nitrofuran antibiotics
🔹 Patient taking interacting medicines (e.g., probenecid, magnesium trisilicate) that can’t be spaced
🔹 Visible blood in urine (haematuria) without infection signs — cancer red flag
🔹 Symptoms lasting >7 days before presentation without treatment
🔹 Vaginal discharge or vaginal irritation — more likely to be thrush or STI, not UTI - refer to GP or sexual health clinic
🔹 Severely immunosuppressed (e.g., chemotherapy, transplant patient, taking immunosurpressants)
🔹 Aged under 16 or over 65 (depending on local PGD — some allow slightly older)
🔹 History of liver or lung damage from previous nitrofurantoin use
🔹stage 3+ CKD

Question 17

common side effects of nitrofuantoin

Answer 17

Nausea, vomiting, anorexia, urine discoloration
dizziness, headahce

Question 18

self care advice for prevention of UTI

Answer 18

wipe from back to front
avoid holding in urine - pass as soon as you need
wee after having sex
wash vulva with water before and after sex
stay hydrated