UTI management protocol pilot program

1) Eligibility

Patient is female. Patient is male or has had gender reassignment surgery. (Usual care & refer)

Age is between 18 and 65 years. Patient consents and is physically present.

2) Rule out red flags

Pyelonephritis signs: fever >38°C, chills, nausea/vomiting, flank pain. (Immediate ED)

Why this matters

Pyelonephritis requires urgent medical assessment.

Immediate GP referral factors

Pregnancy or <6 weeks post‑partum Gross haematuria Neurological disease affecting bladder function (e.g. cerebral palsy) Recent IUD insertion (<3 months) Urinary tract obstruction/abnormality/urolithiasis Catheter (in situ or within last 48 hours) Nephrostomy tube or ureteral stent Spinal cord injury

3) Symptoms of acute uncomplicated UTI

Need 2 or more typical symptoms to support a provisional diagnosis.

Dysuria Urinary frequency Urinary urgency Suprapubic pain/discomfort

Symptoms or history suggest a cause other than UTI (e.g. vaginal thrush, BV, skin conditions). (Consider S3 thrush tx or GP)

4) Other history

These tilt towards pharmacist care and medical review. Antibiotic supply may still be considered if clinically appropriate.

Group A

Diabetes or taking SGLT2 inhibitor Reoccurrence within 2 weeks of completing antibiotics Symptoms persist 48–72 h after starting antibiotics ≥2 symptomatic UTIs in 6 months or ≥3 in 12 months Long‑term inpatient care (incl. RACF)

Group B

STI risk factors (e.g. <29 years, recent new partner, no barrier protection, partner treated for STI, sex worker contact, previous STI) History of pyelonephritis On immunosuppressants / immunocompromised / asplenia Renal disease or impairment IUD in situ (>3 months)

5) Care options

Conservative management (first‑line)

Analgesia: Paracetamol 1 g PO every 4–6 h (max 4 g/day) or Ibuprofen 200–400 mg PO every 6–8 h (max 2.4 g/day).
Self‑care: Provide patient information; increase fluids to 2–3 L/day; educate on UTI prevention.
Review: If symptoms persist after 48 h on conservative management, return for review and consider antibiotics.

Per protocol: most patients <65 y treated symptomatically become symptom‑free within a week; risk of pyelonephritis/sepsis is low and may be reduced by antibiotics.

Documentation requirements

Patient identifiers; date; pharmacist name and HPI‑I.
Consent: pilot participation, costs, GP communication, MHR access/upload as required.
Relevant history, allergies/ADRs; clinical opinion; actions taken; particulars of any medicines supplied.
Information/advice given; share record with patient and the usual GP/medical practice; record supply in approved IT system.

6) Antibiotic therapy (when indicated)

Check allergies, interactions and the specific contraindications below. If all recommended antibiotics are contraindicated, refer to GP.

Antibiotics treatment note:

Follow‑up advice

Symptoms should respond within 48 h of appropriate antibiotics.
If symptoms persist 48–72 h after finishing antibiotics or non‑UTI symptoms develop, advise GP review.
Dispense and label via pharmacy software in line with the Drugs, Poisons and Controlled Substances Regulations 2017.

Side effects & counselling

The protocol directs pharmacists to provide Consumer Medicines Information (CMI). Use the CMI for medicine‑specific side effects and counselling points.

Patient journey

1) Eligibility

2) Rule out red flags

Immediate GP referral factors

3) Symptoms of acute uncomplicated UTI

4) Other history

Group A

Group B

5) Care options

Conservative management (first‑line)

Documentation requirements

6) Antibiotic therapy (when indicated)

Antibiotics treatment note:

Follow‑up advice

Side effects & counselling