Request Antibiotics For Simple Urine Infection (Female adults 66 years and older)

If you think you have a mild urine infection and want to request antibiotics for this, please complete this form.

After 4pm you must phone the surgery, as the request will not be processed until the next working day.

If you feel unwell needing further assessment by a clinician then please contacting the practice or 111/999 (as appropriate depending on the severity)

You must be registered with this practice to submit this form.

Request Antibiotics For Simple Urine Infection (Female adults 66 years and older)

Request Antibiotics For Simple Urine Infection (Female adults 66 years and older)

(Please use this format DD/MM/YYYY)
(Any responses we send will go to this email address)
My symptoms include:
New discomfort as I pass urine:
Or
I need to pass urine more frequently (which is new for me):
An urgent feeling that I need to pass urine (which is new for me):
I am wetting myself (which is new for me):
I confirm that:
I think this is a mild urine infection:
I do NOT have a fever:
I am NOT significantly unwell:
I do NOT have any significant problems with antibiotics:
I do NOT have complicated urinary/kidney problems:
I have NOT seen blood in the urine:
I do NOT have complicated infections or repeated urine infections:
I am NOT vomiting:
I am passing near/normal volumes of urine:
I do NOT have abdominal or loin/kidney pains:
I do NOT have a catheter:
I do NOT have a significant medical problems that might alter the assessment:

If you have been unable to meet all the safety criteria above then please contact the practice when open or 111 service in the out of hours period as a clinician will need to assess you further before proceeding.

Nitrofurantoin/Trimethoprim/Pivmecillinam are commonly prescribed antibiotics for urine infections.

Once your request has been assessed, the clinician will contact you and this might be by text message to let you know that they are sending a prescription to your usual pharmacy. If you feel more unwell please seek urgent clinical advice instead.

The link below gives advice about how to help yourself and what to do if your symptoms change.

www.rcgp.org.uk/clinical-and-research/resources

*
*