A three-day course for urine infections — where local resistance decides whether it is still the right first choice.
Explained by a GMC-registered GP, not a leaflet
Honest about what we can and cannot prescribe remotely
Side effects given the same weight as benefits
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Trimethoprim blocks an enzyme bacteria need to make folate, which they must produce themselves. Without it they cannot build DNA and stop multiplying. Human cells absorb folate from the diet instead, which is why the drug is selective.
That mechanism also explains its main precautions — in pregnancy, and in anyone already low in folate.
Resistance is now high in many parts of the UK, which is why nitrofurantoin has largely replaced it as first choice.
Symptoms usually improve within one to two days. If there is no improvement after 48 hours, the organism may be resistant — which is a reason to check the urine culture rather than simply try another antibiotic blindly.
Tell us if there is any chance you are pregnant or trying to conceive — nitrofurantoin or cefalexin would be used instead.
A short course in a healthy person needs no monitoring. Longer or preventive use, or use alongside the medicines above, warrants checks of kidney function and potassium.
Yes, for uncomplicated urinary infection in women, where the symptom pattern is clear. Urinary infection is one of the conditions that assesses well by history — burning on passing urine, going more often, urgency, and no vaginal discharge together give a high probability.
What needs assessment rather than a remote prescription:
Trimethoprim is one of the cheapest antibiotics available. A three-day private course costs very little — typically well under the England NHS prescription charge.
Cost is not the reason it has slipped down the guidelines. Resistance is, and a cheap antibiotic that does not work is not good value.
Complete the three days even if symptoms settle after one.
For recurrent infection after the menopause, vaginal oestrogen reduces recurrence substantially and is consistently underused. Methenamine hippurate is a non-antibiotic option with reasonable evidence. Both are better long-term answers than repeated antibiotic courses.
Because resistance to trimethoprim is high in many areas. Guidelines follow local resistance data, and nitrofurantoin generally performs better.
Not in the first trimester, and best avoided throughout unless there is no alternative. It interferes with folate, which matters most in early pregnancy. Tell us if there is any possibility.
Trimethoprim commonly raises measured creatinine without actually harming the kidneys. It blocks its secretion into the urine, so the number rises while true function is unchanged. It settles after the course.
Contact us, and make sure a urine sample has been sent. The sensitivity result tells you which antibiotic will work, rather than guessing again.
Alcohol does not interact with trimethoprim. Fluids of any kind help; alcohol is simply a poor choice while symptomatic.
Clinically reviewed by Dr Mohammad Zubair Khan, GMC 7563469
Last reviewed
August 30, 2026
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Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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