URINARY TRACT INFECTIONS

URINARY TRACT INFECTIONS

1. Cystitis (infection in the bladder)

   • Pyelonephritis (infection also involving the kidney)
     • Urosepsis (infection of the urinary tract that results in serious systemic effects)
       • Symptoms: as above + serious systemic side-effects such as high-grade fever, vomiting, rigors
         • Infection is usually caused by gram negative organisms (E.Coli, Klebsiella or Proteus) but can also be caused by Staph Saprophyticus and, less commonly, enterococcus or Streptococcus agalactiae
           • For empirical therapy, use: Gentamicin IV PLUS amoxycillin/ampicillin 2g IV q6h
             • For patients who are hypersensitive to penicillins, use Gentamicin alone for initial therapy
               • If Gentamicin is contraindicated, use: Ceftriaxone 1g IV d OR Cefotaxime 1g IV q8h
     • Symptoms: as above + back/flank pain, low-grade fever
       • For empirical therapy while waiting for the results of urine culture, use: Amoxycillin+Clavulanic acid 875mg+125mg bd for 10-14 days OR Cephalexin 500mg qid for 10-14 days OR Trimethoprim 300mg d n for 10-14 days
         • If resistance to all of the drugs above is confirmed or the pathogen is Pseudomonas Aeruginosa, use Ciprofloxacin 500mg bd for 7 days OR Norfloxacin 400mg bd for 7 days
   • Symptoms: cloudy/foul smelling urine, frequent/painful/burning urination, feeling of incomplete voiding, elevated white blood cell count, confusion in elderly patients
     • Treatment: is the causative organism known? (urine culture takes several days to obtain results)
       • Yes
         • Directed therapy (choose Abx to cover specific organism/s
       • No
         • Empirical therapy (choose Abs MOST LIKELY to cover causative organism/s
           • Most likely to be E.Coli, Staph Saprophyticus, Enterococcus or (less often) Pseudomonas *For uncomplicated UTI* [adult, non-pregnant female with no functional or anatomical abnormalities of the urinary tract]
             • Complicated UTI's (abnormalities of urinary tract, diabetics, men, pregnant women) are only caused by E.Coli 20-50% of the time. Proteus, Klebsiella, Enterococcus and Streptococcus agalactiae are more common in these patients
               • Acute UTI in men First line: Trimethoprim 300mg d n for 7 days
                 • Second line: Cephalexin 500mg bd for 7 days
                   • Third line: Amoxycillin+Clavulanic acid 500mg+125mg bd for 7 days OR Nitrofurantoin 100mg bd for 7 days
                     • If resistance to all of the drugs above is confirmed and the pathogen is susceptible, a suitable alternative would be Norfloxacin 400mg bd for 7 days
               • Acute UTI in a pregnant woman First line: cephalexin 500mg bd for 5 days OR Nitrofurantoin 100mg bd for 5 days
                 • Second line: Amoxycillin+Clavulanic acid 500mg+125mg bd for 5 days
             • First line: Trimethoprim 300mg d n for 3 days
               • Second line: Cephalexin 500mg bd for 5 days
                 • Third line: Amoxycillin+clavulanic acid 500mg+125mg bd for 5 days OR Nitrofurantoin 100mg bd for 5 days
                   • If resistance to all of the drugs above is confirmed and the pathogen is susceptible, a suitable alternative would be Norfloxacin 400mg bd for 3 days