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["Baseline assessment: Urinary tract "]
["infection (lower): antimicrobial prescribing"]
["NG109"]
[]
[]
["Published: October 2018"]

{"sheet":"Introduction","index":1,"n_rows":23,"n_cols":1,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Baseline assessment tool for urinary tract infection (lower): antimicrobial prescribing (NICE antimicrobial prescribing guideline NG109)"]
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["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Urinary tract infection (lower): antimicrobial prescribing.  It can also help to plan activity to meet the recommendations."]
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["The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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["It should be used in conjunction with Urinary tract infection (lower) (NICE antimicrobial prescribing guideline NG109)."]
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["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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["Is the guideline relevant?"]
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["The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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["The table can be adapted to include any other local information that is thought to be useful."]
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["If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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["Tools and resources to help put the guidance into practice are available on the NICE website. "]
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["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2022. All rights reserved. Subject to Notice of rights.\n"]

{"sheet":"Data sheet","index":2,"n_rows":40,"n_cols":10,"rows_kept":40,"cut":false,"hidden":false,"merged":[[0,0,0,9]]}
["Baseline assessment tool for urinary tract infection (lower) (NICE antimicrobial prescribing guideline NG109)"]
[]
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[null,null,null,"Number of recommendations met",{"$f":"COUNTIF(E8:E40,\"Yes\")","v":0}]
[null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(E4/E3),\"\",E4/E3)","v":""}]
[]
["NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1   Managing lower urinary tract infection (cystitis)"]
["Be aware that lower urinary tract infection (UTI) is an infection of the bladder usually caused by bacteria from the gastrointestinal tract entering the urethra and travelling up to the bladder.","1.1.1"]
["Give advice about managing symptoms with self-care (see the recommendations on self-care) to all people with lower UTI.","1.1.2"]
["Treatment for women with lower UTI who are not pregnant"]
["Consider a back-up antibiotic prescription (to use if symptoms do not start to improve within 48 hours or worsen at any time) or an immediate antibiotic prescription (see the recommendations on choice of antibiotic) for women with lower UTI who are not pregnant. Take account of: \n• the severity of symptoms\n• the risk of developing complications, which is higher in people with known or suspected structural or functional abnormality of the genitourinary tract or immunosuppression\n• the evidence for back-up antibiotic prescriptions, which was only in non-pregnant women with lower UTI where immediate antibiotic treatment was not considered necessary \n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria \n• preferences of the woman for antibiotic use. ","1.1.3"]
["If a urine sample has been sent for culture and susceptibility testing and an antibiotic prescription has been given:\n• review the choice of antibiotic when microbiological results are available, and\n• change the antibiotic according to susceptibility results if bacteria are resistant and symptoms are not already improving, using a narrow spectrum antibiotic wherever possible.","1.1.4"]
["Treatment for pregnant women and men with lower UTI"]
["Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) to pregnant women and men with lower UTI. Take account of:\n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria. ","1.1.5"]
["Obtain a midstream urine sample from pregnant women and men before antibiotics are taken, and send for culture and susceptibility testing.","1.1.6"]
["For pregnant women with lower UTI:\n• review the choice of antibiotic when microbiological results are available, and\n• change the antibiotic according to susceptibility results if the bacteria are resistant, using a narrow spectrum antibiotic wherever possible. ","1.1.7"]
["For men with lower UTI:\n• review the choice of antibiotic when microbiological results are available, and\n• change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not already improving, using a narrow spectrum antibiotic wherever possible. ","1.1.8"]
["Treatment for children and young people under 16 years with lower UTI"]
["Obtain a urine sample from children and young people with lower UTI before antibiotics are taken, and dipstick test or send for culture and susceptibility testing in line with the NICE guideline on urinary tract infection in under 16s: diagnosis and management.","1.1.9"]
["Assess and manage children under 5 with lower UTI who present with fever as outlined in the NICE guideline on fever in under 5s.","1.1.10"]
["Offer an immediate antibiotic prescription (see the recommendations on choice of antibiotic) for children and young people under 16 years with lower UTI. Take account of:\n• previous urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria. ","1.1.11"]
["If a urine sample has been sent for culture and sensitivity testing when an antibiotic prescription has been given:\n• review the choice of antibiotic when microbiological results are available, and\n• change the antibiotic according to susceptibility results if the bacteria are resistant and symptoms are not already improving, using a narrow spectrum antibiotic wherever possible.","1.1.12"]
["Advice for all people with lower UTI when an antibiotic prescription is given"]
["When a back-up antibiotic prescription is given, as well as the general advice on self-care, give advice about:\n• an antibiotic not being needed immediately\n• using the back-up prescription if symptoms do not start to improve within 48 hours or if they worsen at any time\n• possible adverse effects of antibiotics, particularly diarrhoea and nausea \n• seeking medical help if antibiotics are taken and:\n- symptoms worsen rapidly or significantly at any time, or\n- symptoms do not start to improve within 48 hours of taking the antibiotic, or\n- the person becomes systemically very unwell.","1.1.13"]
["When an immediate antibiotic prescription is given, as well as the general advice on self-care, give advice about:\n• possible adverse effects of the antibiotic, particularly diarrhoea and nausea \n• seeking medical help if symptoms worsen rapidly or significantly at any time, do not start to improve within 48 hours of taking the antibiotic, or the person becomes systemically very unwell.","1.1.14"]
["Reassessment"]
["Reassess if symptoms worsen rapidly or significantly at any time, or do not start to improve within 48 hours of taking the antibiotic, taking account of:\n• other possible diagnoses\n• any symptoms or signs suggesting a more serious illness or condition, such as pyelonephritis\n• previous antibiotic use, which may have led to resistant bacteria. \nSend a urine sample for culture and susceptibility testing if this has not already been done and review treatment when results are available (see recommendations 1.1.4, 1.1.7, 1.1.8 and 1.1.12).","1.1.15"]
["Referral"]
["Refer people aged 16 years and over with lower UTI to hospital if they have any symptoms or signs suggesting a more serious illness or condition (for example, sepsis).","1.1.16"]
["Refer children or young people with lower UTI to hospital in line with the NICE guideline on urinary tract infection in under 16s: diagnosis and management.","1.1.17"]
["1.2  Managing asymptomatic bacteriuria"]
["Be aware that asymptomatic bacteriuria:\n• is significant levels of bacteria (greater than 105 colony forming units/ml) in the urine with no symptoms of UTI\n• is not routinely screened for, or treated, in women who are not pregnant, men, young people and children\n• is treated with antibiotics in pregnant women because it is a risk factor for pyelonephritis and premature delivery (see the recommendations on choice of antibiotic).","1.2.1"]
["Offer an immediate antibiotic prescription to pregnant women with asymptomatic bacteriuria, taking account of:\n• recent urine culture and susceptibility results\n• previous antibiotic use which may have led to resistant bacteria.","1.2.2"]
["1.3  Self-care"]
["Advise people with lower UTI about using paracetamol for pain, or if preferred and suitable ibuprofen.","1.3.1"]
["Advise people with lower UTI about drinking enough fluids to avoid dehydration.","1.3.2"]
["Be aware that no evidence was found on cranberry products or urine alkalinising agents to treat lower UTI.","1.3.3"]
["1.4  Choice of antibiotic"]
["When prescribing antibiotic treatment for lower UTI, take account of local antimicrobial resistance data and follow:\n• table 1 for non-pregnant women aged 16 years and over\n• table 2 for pregnant women aged 12 years and over\n• table 3 for men aged 16 years and over\n• table 4 for children and young people under 16 years.","1.4.1"]

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["Table 1. Antibiotics for non-pregnant women aged 16 years and over"]
["Treatment","Antibiotic, dosage and course length"]
["First choices\nIf there are symptoms of pyelonephritis (such as fever) or a complicated urinary tract infection (UTI), see the NICE guideline on acute pyelonephritis for antibiotic choices.","Nitrofurantoin (if estimated glomerular filtration rate [eGFR] is 45 ml/minute or more):\n100 mg modified-release twice a day (or, if unavailable, 50 mg four times a day) for 3 days\nTrimethoprim (if there is a low risk of resistance):\n200 mg twice a day for 3 days"]
["Second choices (if no improvement in lower UTI symptoms on first choice taken for at least 48 hours, or when first choice is not suitable)\nIf there are symptoms of pyelonephritis (such as fever) or a complicated UTI, see the NICE guideline on acute pyelonephritis for antibiotic choices.","Nitrofurantoin (if eGFR is 45 ml/minute or more, and it was not used as first-choice):\n100 mg modified-release twice a day (or, if unavailable, 50 mg four times a day) for 3 days\nPivmecillinam (a penicillin):\n400 mg initial dose, then 200 mg three times a day for a total of 3 days\nFosfomycin:\n3 g single dose sachet"]
["See the BNF for appropriate use and dosing in specific populations, for example, in hepatic or renal impairment, and breastfeeding."]
["Check any previous urine culture and susceptibility results, and antibiotic prescribing, and choose antibiotics accordingly."]
["Nitrofurantoin may be used with caution if eGFR is 30 ml/minute to 44 ml/minute to treat uncomplicated lower UTIs caused by suspected or "]
["proven multidrug-resistant bacteria and only if potential benefit outweighs risk (BNF, August 2018)."]
["A lower risk of resistance may be more likely if trimethoprim has not been used in the past 3 months, previous urine culture suggests "]
["susceptibility (but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of "]
["resistance may be more likely with recent use and in older people in residential facilities."]

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["Table 2 Antibiotics for pregnant women aged 12 years and over"]
["Treatment","Antibiotic, dosage and course length"]
["First choice\nIf there are symptoms of pyelonephritis (such as fever) or a complicated urinary tract infection (UTI), see the NICE guideline on acute pyelonephritis for antibiotic choices.","Nitrofurantoin (if estimated glomerular filtration rate [eGFR] is 45 ml/minute or more):\n100 mg modified-release twice a day (or, if unavailable, 50 mg four times a day) for 7 days\nAvoid at term because it may produce neonatal haemolysis (BNF, August 2018)"]
["Second choices (if no improvement in lower UTI symptoms on first choice taken for at least 48 hours, or when first choice is not suitable)\nIf there are symptoms of pyelonephritis (such as fever) or a complicated UTI, see the NICE guideline on acute pyelonephritis for antibiotic choices.","Amoxicillin (only if culture results are available and susceptible):\n500 mg three times a day for 7 days\nCefalexin:\n500 mg twice a day for 7 days"]
["Alternative second choices","Consult local microbiologist, and choose antibiotics based on culture and susceptibility results"]
["Treatment of asymptomatic bacteriuria","Choose from nitrofurantoin, amoxicillin or cefalexin based on recent culture and susceptibility results"]
["See the BNF for appropriate use and dosing in specific populations, for example, in hepatic or renal impairment."]
["Check any previous urine culture and susceptibility results, and antibiotic prescribing, and choose antibiotics accordingly."]
["Nitrofurantoin may be used with caution if eGFR is 30 ml/minute to 44 ml/minute to treat uncomplicated lower UTIs caused by suspected or "]
["proven multidrug-resistant bacteria and only if potential benefit outweighs risk (BNF, August 2018)."]

{"sheet":"Table 3","index":5,"n_rows":8,"n_cols":2,"rows_kept":8,"cut":false,"hidden":false,"merged":[]}
["Table 3 Antibiotics for men aged 16 years and over"]
["Treatment","Antibiotic, dosage and course length"]
["First choices\nIf there are symptoms of pyelonephritis (such as fever) or a complicated urinary tract infection (UTI), see the NICE guideline on acute pyelonephritis for antibiotic choices.","Trimethoprim:\n200 mg twice a day for 7 days\nNitrofurantoin (if estimated glomerular filtration rate [eGFR] is 45 ml/minute or more):\n100 mg modified-release twice a day (or, if unavailable, 50 mg four times a day) for 7 days\nNitrofurantoin is not recommended for men with suspected prostate involvement because it is unlikely to reach therapeutic levels in the prostate."]
["Second choices (if no improvement in lower UTI symptoms on first choice taken for at least 48 hours, or when first choice is not suitable)\nIf there are symptoms of pyelonephritis (such as fever) or a complicated UTI, see the NICE guideline on acute pyelonephritis for antibiotic choices.","Consider alternative diagnoses and follow recommendations in the NICE guideline on pyelonephritis (acute): antimicrobial prescribing or the NICE guideline on prostatitis (acute): antimicrobial prescribing, basing antibiotic choice on recent culture and susceptibility results."]
["See the BNF for appropriate use and dosing in specific populations, for example, in hepatic or renal impairment."]
["Check any previous urine culture and susceptibility results, and antibiotic prescribing, and choose antibiotics accordingly."]
["Nitrofurantoin may be used with caution if eGFR is 30 ml/minute to 44 ml/minute to treat uncomplicated lower UTIs caused by suspected or"]
["proven multidrug-resistant bacteria and only if potential benefit outweighs risk (BNF, August 2018)."]

{"sheet":"Table 4","index":6,"n_rows":16,"n_cols":2,"rows_kept":16,"cut":false,"hidden":false,"merged":[]}
["Table 4 Antibiotics for children and young people under 16 years"]
["Treatment","Antibiotic, dosage and course length"]
["Children under 3 months","Refer to a paediatric specialist and treat with intravenous antibiotics in line with the NICE guideline on fever in under 5s"]
["First choices for children aged 3 months and over\nIf there are symptoms of pyelonephritis (such as fever) or a complicated UTI, see the NICE guideline on acute pyelonephritis for antibiotic choices.\nIf 2 or more antibiotics are appropriate, choose the antibiotic with the lowest acquisition cost. Some children may also be able to take a tablet or part-tablet, rather than a liquid formulation, if the dose is appropriate.","Trimethoprim (if there is a low risk of resistance):\n3 months to 5 months, 4 mg/kg (maximum 200 mg per dose) or 25 mg twice a day for 3 days\n6 months to 5 years, 4 mg/kg (maximum 200 mg per dose) or 50 mg twice a day for 3 days\n6 years to 11 years, 4 mg/kg (maximum 200 mg per dose) or 100 mg twice a day for 3 days\n12 years to 15 years, 200 mg twice a day for 3 days\nNitrofurantoin (if estimated glomerular filtration rate (eGFR) is 45 ml/minute or more):\n3 months to 11 years, 750 micrograms/kg four times a day for 3 days\n12 years to 15 years, 50 mg four times a day or 100 mg modified-release twice a day for 3 days"]
["Second choices for children aged 3 months and over (if no improvement in lower UTI symptoms on first choice taken for at least 48 hours, or when first choice is not suitable)\nIf there are symptoms of pyelonephritis (such as fever) or a complicated UTI, see the NICE guideline on acute pyelonephritis for antibiotic choices.\nIf 2 or more antibiotics are appropriate, choose the antibiotic with the lowest acquisition cost. Some children may also be able to take a tablet or part-tablet, rather than a liquid formulation, if the dose is appropriate.","Nitrofurantoin (if eGFR is 45 ml/minute or more and it was not used as first-choice):\n3 months to 11 years, 750 micrograms/kg four times a day for 3 days\n12 years to 15 years, 50 mg four times a day or 100 mg modified-release twice a day for 3 days\nAmoxicillin (only if culture results available and susceptible):\n1 month to 11 months, 125 mg three times a day for 3 days\n1 year to 4 years, 250 mg three times a day for 3 days\n5 years to 15 years, 500 mg three times a day for 3 days\nCefalexin:\n3 months to 11 months, 12.5 mg/kg or 125 mg twice a day for 3 days\n1 year to 4 years, 12.5 mg/kg twice a day or 125 mg three times a day for 3 days\n5 years to 11 years, 12.5 mg/kg twice a day or 250 mg three times a day for 3 days\n12 years to 15 years, 500 mg twice a day for 3 days"]
["See the BNF for children (BNFC) for appropriate use and dosing in specific populations, for example, in hepatic or renal impairment. See table 2 "]
["if a young woman is pregnant."]
["The age bands apply to children of average size and, in practice, the prescriber will use the age bands with other factors such as the severity of"]
["the condition being treated and the child’s size in relation to the average size of children of the same age."]
["Check any previous urine culture and susceptibility results, and antibiotic prescribing. and choose antibiotics accordingly. When a child or young "]
["person is having prophylactic antibiotics, treatment should be with a different antibiotic, not a higher dose of the same antibiotic."]
["Nitrofurantoin may be used with caution if eGFR is 30 ml/minute to 44 ml/minute to treat uncomplicated lower UTIs caused by suspected or proven"]
["multidrug-resistant bacteria and only if potential benefit outweighs risk (BNFC, August 2018)."]
["A lower risk of resistance may be more likely if trimethoprim has not been used in the past 3 months, previous urine culture suggests susceptibility"]
["(but this was not used), and in younger people in areas where local epidemiology data suggest resistance is low. A higher risk of resistance may"]
[" be more likely with recent use and in older people in residential facilities."]