Urinary tract infections

Question 1

Symptoms

Answer 1

Dysuria, increased urinary frequency, offensive smelling, lower abdominal pain, low grade fever, confusion in the elderly.

Question 2

Types

Answer 2

Uncomplicated and complicated e.g. from a catheter, stones etc

Question 3

Causative organisms

Answer 3

Gram negative anaerobes e.g. E. Coli

Question 4

Treatment

Answer 4

Non-pregnant women- 3 days of nitrofurantoin if eGFR > 30 or trimethoprim. If that fails do a urine culture.

Pregnant women- always send urine culture. 1st line Nitrofurantoin as long as not near term, 2nd line amoxicillin/cefalexin. Trimethoprim is teratogenic.

Men- 7 days of nitrofurantoin or trimethoprim.

Question 5

Acute bacterial prostatitis- cause, symptoms, treatment

Answer 5

Acute bacterial prostatitis
Caused by gram negative bacteria (E. coli) asending urethra and entering the prostate gland.
Pain in perineum, rectum, scrotum, penis, bladder and lower back. Fever, rigors.
PR exam will show a tender swollen prostate.
Management: 14 days of ciprofloxacin, consider an STI screen.

Question 6

Acute pyelonephritis- cause, symptoms, treatment

Answer 6

Caused by an ascending UTI.
Symptoms: Fever, rigors, loin pain, vomiting, white cell casts in urine.
Treatment: ciprofloxacin or co-amoxiclav