GGC Medicines: HEPMA Stop Date for Nitrofurantoin and Trimethoprim in the treatment of UTI/cystitis

HEPMA Stop Date for Nitrofurantoin and Trimethoprim in the treatment of UTI/cystitis

Improving Antimicrobial Stewardship in NHSGGC:

Promoting HEPMA Stop Date Recording for Oral Nitrofurantoin and Trimethoprim in the treatment of lower Urinary Tract Infection (UTI)/Cystitis

Key messages

Antimicrobial Stewardship (AMS) involves prescribing the right antibiotic, via the right route, at the right time, and dose, and for the right duration.
Giving an antibiotic for the wrong duration can have serious consequences. If it is given for too short a time this can result in treatment failure. If given for longer than required, this can increase patient risk of adverse effects (e.g. Clostridioides difficile infection), increase healthcare costs, and most worryingly, increase the risk of the development of antibiotic resistance.
In NHSGGC, trimethoprim and nitrofurantoin are commonly prescribed in the management of lower UTI (See Table 1). In order to improve AMS and ensure that these oral antibiotics are prescribed for the correct treatment duration, the recording of stop dates on HEPMA for lower UTI treatment is now mandatory. See example screenshots below on how to use HEPMA to prescribe trimethoprim and nitrofurantoin with mandatory stop dates.

Table 1

Common lower UTI indications and the appropriate trimethoprim and nitrofurantoin durations (doses recommended are based on normal renal/liver function)

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Indication Lower UTI / Cystitis	Antibiotic (oral)	Dose	Duration
Non pregnant women	Nitrofurantoin MR	100mg 12 hourly	3 days
	Nitrofurantoin	50mg 6 hourly
	Trimethoprim	200mg 12 hourly
Pregnant women (1st and 2nd trimesters only)	Nitrofurantoin MR	100mg 12 hourly	7 days
Pregnant women (1st and 2nd trimesters only)	Nitrofurantoin	50mg 6 hourly	7 days
Males	Nitrofurantoin MR	100mg 12 hourly	7 days
	Nitrofurantoin	50mg 6 hourly
	Trimethoprim	200mg 12 hourly

Example screenshots

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Mandatory stop dates for lower UTI on HEPMA

Select trimethoprim or nitrofurantoin. Drug notes give instruction on treatment options:

For lower UTI treatment

Then select appropriate indication

Enter the dose and frequency in the order entry. The system will automatically select the appropriate duration for each indication.
For example Adult Female Lower UTI (non pregnant)

For example Adult Male Lower UTI

Note: examples above are for trimethoprim, however, the same process applies to nitrofurantoin for lower UTI treatment.

Further Prescribing Information

For further advice on the management of UTI infections refer to NHSGGC Empirical Infection Management Guidelines / GGC Adult Therapeutics Handbook and SAPG UTI Management Guidance
For further advice on the management of UTI in pregnancy refer to NHSGGC Antibiotic policy, obstetric patients
For full prescribing information on trimethoprim and nitrofurantoin please refer to the BNF, the SPC via emc and the Renal Drug Database (GGC staff email knowledge@nes.scot.nhs.uk for log in details)

Written by NHSGGC Antimicrobial Pharmacy Team and HEPMA team in collaboration with the Communications subcommittee of ADTC.

Published 01/03/2023. Medicines Update blogs are correct at the time of publishing.