Dysuria

Question 1

Criteria for diagnosis of UTI on MSU

Answer 1

presence of leucocytes + growth of >10(5) colony forming units/ml on culture

Question 2

What indicates contamination of an MSU

Answer 2

epithelial cells

Question 3

Management of uncomplicated UTI in adults

Answer 3

empirical treatment with trimethoprim 200mg bd or nitrofuratoin 50mg qds (or 100mg MR bd)
3/7 in women
7/7 in men

Question 4

What is an uncomplicated UTI (adults)

Answer 4

UTI caused by typical pathogen in person with normal urinary tract and normal renal function

Question 5

Side effects of trimethoprim

Answer 5

uncommon

Question 6

Side effects of nitrofuratoin

Answer 6

nausea and vomiting

Question 7

When to avoid nitrofuratoin in non-pregnant patients

Answer 7

eGFR <45 (review recent eGFR if possible)

Question 8

Management of UTI in pregnancy

Answer 8

• nitrofuratoin (avoid 3rd trimester) or trimethoprim (avoid 1st trimester and if on anti-folate e.g. AED)
• ‘give Nitrofuratoin if New pregnancy (1st trimester), give Trimethoprim if Third trimester’
• 2nd line: amoxicillin or cefalexin

Question 9

Management of acute pyelonephritis

Answer 9

• broad spectrum Abx 7/7 e.g. ciprofloxacin or co-amoxiclav

- contact Dr if not improved by 24h as may need admission

Question 10

When to definitely send an MSU in UTI

Answer 10

• children
• unwell elderly people
• complications
• co-morbidities

Question 11

What to advise patients if you send for MSU

Answer 11

phone 2 days later for results as may need different Abx/may not be UTI

Question 12

Dysuria: when to refer

Answer 12

• recurrent or unexplained cystitis, especially associated with microscopic haematuria
• failure to respond to treatment
• painless macroscopic haematuria at any age
• > 50 with unexplained microscopic haematuria