Prostatitis/Pyelonephritis Acute (both)

Question 1

Background

Answer 1

Pyelonephritis
Infection of 1/both kidneys usually caused by bacteria from the bladder.
Complications:
Sepsis, Renal abscess formation, Preterm labour, Recurrent UTI,

Prostatitis
Severe and life threatening bacterial infection in prostate. Caused by urethral instrumentation, trauma, bladder outflow obstruction or dissemination of infection outside UT. Most men treated in 2 weeks.

Question 2

Symptoms/Diagnosis

Answer 2

Pyelonephritis
UTI signs (eg dysuria, Frequency, urgency) + Fever, N, V, flank pain
Diagnosis: Done by detailed medical Hx + physical exam, should take MSU or catheter. Final diagnosis by looking for loin pain and/or fever and other causes of these 2 been excluded.

Prostatitis
- UTI signs (Dysuria, frequency, urgency)
- Prostatitis perineal, penile, or rectal pain; acute urinary retention, obstructive voiding symptoms; low back pain, pain on ejaculation; tender, swollen, warm prostate (on gentle rectal examination).
- Bacteraemia Rigors, fever, tachycardia

Assessment/Diagnosis:
MSU to confirm UTI via dipstick, culture and sensitivity
Arrange blood culture and FBC.
Physical exam - genital exam and digital rectal exam.
Screen for STIs

Question 3

Treatment

Answer 3

IV antibiotics = if severely unwell or unable to take oral treatment and can be combined if concerned about susceptibility or sepsis.
Pyelonephritis
Refer IF also dehydrated or unable to take oral fluids and meds, pregnant or higher risk of getting complications

Non-pregnant women and men
Oral 1st line:
Cefalexin, or ciprofloxacin. If sensitivity known: co-amoxiclav, or trimethoprim.

IV 1st line:
- Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, or gentamicin. Co-amoxiclav may be used if given in combination or sensitivity known.

IV 2nd line:
Consult local microbiologist.

Pregnant women
Oral 1st line:
Cefalexin.
IV 1st line:
Cefuroxime.

2nd line or combining antibacterials if concerned about susceptibility or sepsis:
Consult local microbiologist.

Prostatitis
Refer if no improvement in 48 hours or signs or symptoms suggestive of a more serious condition such as sepsis, acute urinary retention, or prostatic abscess.

Oral 1st line:
Ciprofloxacin, or ofloxacin.
ALT 1st line (fluoroquinolones unable): trimethoprim.
Oral 2nd line (on specialist advice):
Levofloxacin, or co-trimoxazole.

IV 1st line:
Amikacin, ceftriaxone, cefuroxime, ciprofloxacin, gentamicin, or levofloxacin.
Iv 2nd line:
Consult local microbiologist.