LOWER URINARY TRACT INFECTION

Question 1

What are the symptoms of a UTI?

Answer 1

• New nocturia
• Dysuria
• Cloudy, foul smelling urine

Question 2

Causes of UTI

Answer 2

• Caused by bacteria (E. coli) that come from the GI tract and enter the bladder/urethra.

Question 3

RF of UTI

Answer 3

• Female
• Sexual activity
• Pregnancy
• Post-menopausal
• Diabetes

Question 4

Consider the risk of deterioration or serious illness

Answer 4

Consider calculating NEWS2 Score ahead of signposting patient to A&E or calling 999 in a life threatening emergency

Question 5

Check for any new signs/symptoms of PYELONEPHRITIS:

Answer 5

☐ Kidney pain/tenderness in back under ribs
☐ New/different myalgia, flu like illness
☐ Shaking chills (rigors) or temperature 37.9°C or above
☐ Nausea/vomiting

Urgent same day referral General practice
Relevant out of hours service

Question 6

Treatment in men

Answer 6

immediate abx rx and midstream urine sample
1. nitro/trim
2. if no improvement after 48h consider
- pyelo
- prostatitis

Question 7

Nitrofurantoin and eGFR

Answer 7

Nitrofurantoin should only be used if eGFR ≥45 ml/minute

Question 8

Onward referral criteria

Answer 8

☐ Vaginal discharge: 80% do not have UTI (treat over the counter if signs and symptoms of thrush)
☐ Urethritis: inflammation post sexual intercourse, irritants
☐ Check sexual history to exclude sexually transmitted infections
☐ Check for signs and symptoms of pregnancy- ask about missed or lighter periods- carry out a pregnancy test if unsure
☐ Genitourinary syndrome of menopause (vulvovaginal atrophy)
☐ Is the patient immunosuppressed?

Question 9

Treatment in Non-Pregnant Women

Answer 9

1. FIRST: Nitrofurantoin or Trimethoprim
2. SECOND: Nitrofurantoin (if not used 1st), Pivmecillinam or Fosfomycin or amoxicillin (hgih rate of reistance so only use if culture susceptible)

Question 10

Treatment in Pregnant Women:

Answer 10

1. FIRST: Nitrofurantoin 100mg mr bd for 7 days (avoid at term)
2. SECOND Cefalexin or Amoxicillin

Question 11

When should nitrofurantoin be avoided in pregnant women?

Answer 11

At term

Question 12

Trimethoprim in pregnancy

Answer 12

• NOTE: trimethoprim is teratogenic
• Trimethoprim, phenytoin are antifolates which must be avoided in pregnancy

Question 13

Nitrofurantoin dose

Answer 13

immediate release: 50mg QDS;
modified-release: 100mg BD;
prophylaxis: 50-100mg nocte - 100mg trigger exposure

Question 14

Treatment duration

Answer 14

Men: 7 days treatment
Pregnancy: 7 days treatment
Uncomplicated women: 3 days treatment
Catheter Associated: 7 days treatment

Question 15

Cystitis vs urethritis

Answer 15

urethritis = inflammation of the urethra
Cystitis = inflammation of the bladder

Question 16

when are UTIs considered recurrent (2)

Answer 16

at least 2 episodes within 6 months
or three or more episodes within 12 months