Treat Uncomplicated Urinary Tract Infection With
Nitrofurantoin

Nitrofurantoin is a first-line antibiotic for treating uncomplicated lower urinary tract infections (UTIs/cystitis) in women, as recommended by NICE. It is available as 50 mg and 100 mg capsules, with the modified-release formulation (Macrobid 100 mg) being the most commonly prescribed. Nitrofurantoin works by damaging bacterial DNA, and it achieves high concentrations in urine, making it particularly effective for bladder infections. Through the NHS Pharmacy First service, pharmacists can assess UTI symptoms and supply nitrofurantoin directly without a GP appointment.

Modified-release (Macrobid): 100 mg twice daily for 3 days (uncomplicated UTI in women). Standard release: 50 mg four times daily for 3 days, or 100 mg four times daily for 3 days for more severe infections. Take with food or milk to improve absorption and reduce nausea. The modified-release formulation is preferred due to twice-daily dosing and fewer gastrointestinal side effects. Complete the full 3-day course.

Nitrofurantoin is first-line because of very low bacterial resistance rates (less than 5% of UK E. coli isolates are resistant — compared to much higher resistance rates for trimethoprim). It concentrates in urine rather than blood, making it highly effective for bladder infections with minimal impact on gut bacteria. It has been used for decades with consistently low resistance, making it a cornerstone of UTI treatment.

Yes, the NHS Pharmacy First service allows pharmacists to assess UTI symptoms in women aged 16–64 and supply nitrofurantoin without a GP appointment. The pharmacist will ask about your symptoms, check for any red flag features requiring GP referral (such as fever, loin pain, or recurrent UTIs), and supply a 3-day course of nitrofurantoin if appropriate. This is a free NHS service.

Common side effects include nausea (reduced by taking with food), diarrhoea, and loss of appetite. The urine may turn dark yellow or brown — this is harmless. Uncommon side effects include headache, dizziness, and drowsiness. Rare but important side effects include pulmonary reactions (shortness of breath, cough — more common with long-term use) and peripheral neuropathy (tingling in hands/feet). Nitrofurantoin should not be used in patients with significant kidney impairment (eGFR <45 mL/min) as it will not achieve adequate urine concentrations.

Nitrofurantoin is not suitable for patients with significant renal impairment (eGFR below 45 mL/min), G6PD deficiency, or at term pregnancy (risk of neonatal haemolysis). It should not be used for upper urinary tract infections (pyelonephritis) as it does not achieve adequate blood levels. The pharmacist will check these before supplying. If nitrofurantoin is unsuitable, trimethoprim may be offered as an alternative.

Many women notice symptom improvement within 24–48 hours of starting nitrofurantoin. Burning and frequency should improve within the first day or two. Complete the full 3-day course even if symptoms resolve earlier, to ensure the infection is fully cleared. If symptoms are not improving after 48 hours, or if they worsen, return to the pharmacy or see your GP.

Drink plenty of water to help flush bacteria from the bladder. Use paracetamol or ibuprofen for pain and discomfort. Avoid caffeine and alcohol, which can irritate the bladder. Some women find cranberry products helpful for prevention, though evidence is mixed. Wipe front to back after using the toilet. Urinate after sexual intercourse. Seek urgent medical advice if you develop fever, loin/back pain, vomiting, or blood in urine — these may indicate a more serious kidney infection.

NHS Pharmacy First is a free service that lets you get a remote video consultation and treatment for six common conditions without visiting your GP. It is available through NowPatient to NHS patients aged 18 and over in England.

The service covers six conditions: sinusitis, sore throats, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections (UTIs) in women. Each condition is subject to an eligibility screening before you can book a consultation.

Yes, the video consultation is completely free. If your clinician prescribes medication and you are not exempt from NHS prescription charges, you will pay a single NHS prescription charge. If you are exempt (for example, you are over 60 or on Income Support), there is no charge at all.

No. The service is commissioned by NHS England and is only available to patients registered with a GP in England. It is not available in Scotland, Wales, Northern Ireland, or outside the UK.

You are eligible if you are aged 18 or over and registered with the NHS in England. You must also pass a condition-specific eligibility screening, which is carried out by an assessment tool before you can book your consultation.

If you do not qualify for the service, NowPatient will signpost you to the right NHS care provider or service so you can still get the help you need. You can also download a referral note, explaining why you failed the assessment.

No. NHS Pharmacy First through NowPatient currently covers only the six listed conditions. For other conditions, please contact your GP or visit an NHS walk-in centre.

Log in to your NowPatient account and go to the NHS Pharmacy First Service Card in the NHS Hub. Select your condition, complete the eligibility screening, and if you qualify, follow the prompts to choose your preferred date, time, and clinician.

Yes. During booking, you can browse available clinicians and filter by gender and spoken languages. You can view each clinician’s name, licence number, and credentials before making your choice.

After booking, you will see a ‘Pre-consultation Requirements’ section with tips on how to prepare. You will also be asked to provide your consultation address and emergency contact details. You can opt in to receive an SMS reminder 30 minutes before your appointment.

The clinician will ask you questions to assess your condition and explore treatment options. If treatment is appropriate, you and the clinician will agree on the best option together. Medication is not guaranteed — it is provided only at the clinician’s discretion.

With your consent, the clinician may inform your GP of the treatment prescribed. We recommend agreeing to this, as your GP is responsible for your overall care and should have a record of the consultation.

Yes. You will receive an in-app and push notification summarising the consultation outcome, including any referrals to your GP and advice given by the clinician. You can view this in the ‘Notifications’ section of your homepage.

If your clinician prescribes medication, you will be directed to your Cart to complete the checkout process. This includes confirming your NHS exemption status, choosing a delivery address and method, and submitting payment.

If you are not exempt from NHS prescription charges, you will pay a single prescription charge per item. If you are exempt, you will not be charged. You will be asked to confirm your exemption status during checkout.

Yes. During the consultation, we will ask for your consent to provide the service. This allows us to communicate with your GP and share information with NHS England, NHS Improvement, and the NHS Business Services Authority (NHSBSA) when required.

Our clinicians are board-certified pharmacists registered with the General Pharmaceutical Council (GPhC). All clinicians undergo DBS background checks and a comprehensive licence verification process. The conditions and medications they can prescribe are strictly governed and reviewed in line with NHS guidelines.

Yes. The service is classified as a Class I medical device under UK MDR 2002 regulations. It complies with NHS standards DTAC, DCB 0160, and DCB 0129. Consultations are delivered via live video to ensure clinical safety and appropriate prescribing.

Yes. NowPatient operates from a HIPAA, DTAC, and Cyber Essentials Plus certified platform that ensures the highest levels of information security. Clinicians access systems on a zero-trust basis with single sign-on (SSO) technology.

Yes. As an NHS patient, our clinicians can access your GP record, including your medications, observations, and investigations. This helps them assess your condition safely and accurately.

We deliver to all postcodes in England. Some rural areas may experience slightly longer delivery times.

All orders are shipped in discreet, unmarked packaging. Temperature-sensitive medications are sent in cold chain-validated packaging to ensure product quality and safety.

We offer Royal Mail Standard Tracked & Signed (2–3 days) and Royal Mail Special Delivery (next working day, guaranteed before 1pm). Orders placed before 3pm Monday–Friday are dispatched the same day.

Your first order must be delivered to the address registered with NowPatient. After that, you can choose any delivery address, including your workplace.

Check the tracking details in the ‘Notification Feed’ section of your dashboard. If your delivery has not arrived within 10 days of the dispatch notification, contact us and we will work to resolve the issue.

NowPatient sends status updates by email and in-app notifications at every stage of your order, from placement through to delivery.

Yes. NowPatient’s pharmacists provide medication advice and counselling across all dispensing services. If you have questions about your prescribed medication, our pharmacy team is available to help.

You may receive a short survey about your experience. We encourage you to complete it, as your feedback helps us improve the service. It is especially helpful if you highlight areas for improvement.

You may be entitled to free NHS prescriptions from the NHS Pharmacy Service if you meet specific eligibility criteria. To claim exemption, the appropriate category must be selected on the prescription form and valid evidence may be required. The exemption categories are listed below:

Age-Related Exemptions

• A: Aged 60 or over, or under 16 (unless date of birth is printed on the form)

• B: Aged 16, 17, or 18 and in full-time education

Certificate-Based Exemptions

• D: Maternity exemption certificate

• E: Medical exemption certificate

• F: Prescription prepayment certificate

• W: HRT-only prescription prepayment certificate

• G: Ministry of Defence prescription exemption certificate

• L: HC2 (full help) certificate

Benefit-Related Exemptions

• H: Receiving Income-related Employment and Support Allowance (ESA)

• S: Receiving Pension Credit Guarantee Credit (including partners)

• U: Receiving Universal Credit and meeting eligibility criteria (Earnings ≤ £435, or ≤ £935 [if UC includes child element or limited capability for work)], in most recent assessment period)

Important

You must only claim an exemption if they are entitled to it. Incorrect claims can result in penalty charges. Proof of eligibility should be provided if requested when collecting medication.

Prescription Item Level Exemptions

You may be entitled to certain medication items for free as listed below. Make sure you declare this when you checkout your prescription order.

• For Contraceptive Use

• For STI (Sexually Transmitted Infection) Treatment

• For latent or active Tuberculosis (TB) or to treat adverse effects of TB treatment

Check if you have an exemption from paying NHS costs

You can check your exemption status by clicking below