UTI

Question 1

What is UTI?

Answer 1

Cystitis – infection of the bladder
SMx: dysuria, urgency, frequency, burning

Pyelonephritis – infection of the kidneys
SMx: same as cystitis PLUS flak pain and tenderness, more acutely ill

Question 2

Causative pathogens?

Answer 2

Uncomplicated UTI - mainly occur in non pregnant women with no functional or anatomical abnormalities of the urinary tract.

• E. Coli (70-90%)
• staphylococcus (10%)

Complicated UTI - associated with functional or anatomical abnormalities eg. Diabetes, nephrolithiasis

• E. Coli (20-50%)
• gram negative bacteria eg. Proteus, Klebsiella
• entrococci
• streptococcus

Question 3

Treatment of acute cystitis in non pregnant women?

Answer 3

1) trimethoprim 300mg n for 3 days
2) cephalexin 500mg bd for 5 days
3) amoxycillin + clavulanate 500/125mg bd for 5 days
3) nitrofurantoin 100mg bd for 5 days

Resistance:
Norfloxacin 400mg bd for 3 days

Question 4

Treatment of acute cystitis in pregnant women?

Answer 4

1) cephalexin 500mg bd for 5 days (Cat A)
2) nitrofurantoin 100mg bd for 5 days (Cat A)
3) amoxycillin + clavulanate 500/125mg bd for 5 days (Cat B1)

Question 5

Treatment of acute cystitis in men?

Answer 5

1) trimethoprim 300mg n for 14 days
2) cephalexin 500mg bd for 14 days
3) amoxycillin + clavulanate 500/125mg bd for 14 days

Question 6

Treatment of MILD acute pyelonephritis?

Answer 6

1) cephalexin 500mg qid for 10 days
1) amoxycillin + clavulanate 875/125mg bd for 10 days
1) trimethoprim 300mg n for 10 days

Resistance:
Norfloxacin 400mg bd for 10 days
OR
Ciprofloxacin 500mg bd for 10 days

Question 7

Treatment of SEVERE pyelonephritis?

Answer 7

Gent IV for one dose and max of 2further doses based on the renal function
PLUS
Amoxy/ampicillin IV

If penicillin hypersensitivity, gent alone will suffice but if gent C/I:
Ceftriaxone IV
OR
Cefotaxime IV