UTIs

Question 1

1) Who are UTIs more common in? males or females?
2) Recurrent episodes of infection are an indication for radiological investigation, why is this particularly important in children?

Answer 1

1) women

2) in children untreated pyelonephritis may lead to permanent kidney damage

Question 2

what is the most common cause of a UTI?

Answer 2

1) Escherichia coli

2) Staphylococcus saprophyticus in sexually active young women

Question 3

A specimen of urine should be collected for culture and sensitivity testing before starting antibacterial therapy in which individuals?

• Treatment should not be delayed while waiting for results.

Answer 3

1) Men, pregnant women, children under 3 years of age
2) Patients with suspected upper UTI; or recurrent
3) if resistant organisms are suspected
4) if urine dipstick testing gives a single positive result for leucocyte esterase or nitrite
5) symptoms not consistent with results of dipstick

Question 4

what is the treatment for an uncomplicated lower urinary-tract infection and the duration?

Answer 4

1) Trimethoprim or nitrofurantoin,
↳ amoxicillin, ampicillin or oral cephalosporin
2) 7 days, but a short course e.g. 3 days is usually adequate for uncomplicated infections in women.
3) if resistant : co-amoxiclav or nitrofurantoin

Question 5

Long-term low dose therapy may be required to prevent recurrence of infection; indications include frequent relapses and significant kidney damage. what drugs can be used long term?

Answer 5

1) Trimethoprim
2) Nitrofurantoin
3) Cefalexin

Question 6

when might Methenamine hippurate be considered for the treatment of a UTI?

Answer 6

1) requires an acidic urine for its antimicrobial activity and it is ineffective for UPPER urinary-tract infections
2) but can be used for prophylaxis and treatment of chronic or recurrent uncomplicated lower urinary-tract infections.

Question 7

upper urinary-tract infections include acute pyelonephritis which can lead to septicaemia. what is the treatment for acute pyelonephritis?

Answer 7

1) initially by injection of a B-Spec cephalosporin (e.g. cefuroxime) or a quinolone if the patient is severely ill
2) treatment is 10–14 days

Question 8

what is the treatment for Prostatitis?

Answer 8

1) antibacterial which penetrates prostatic tissue such as some of the quinolones (ciprofloxacin or ofloxacin)
2) or alternatively, trimethoprim
3) Suggested duration of treatment is 28 days.

Question 9

Urinary-tract infection in pregnancy may be asymptomatic and requires prompt treatment to prevent progression to acute pyelonephritis. which drugs are used in pregnancy?

Answer 9

1) Penicillins and cephalosporins are suitable for treating urinary-tract infection during pregnancy
2) Avoid Nitro at term, and trimethoprim avoided particularly in the first trimester
3) Avoid Sulfonamides and quinolones

Question 10

how are UTIs managed in renal impairment?

Answer 10

1) Antibacterials normally excreted accumulate with resultant toxicity unless the dose is reduced.
2) Avoid completely : tetracyclines, methenamine hippurate, and nitrofurantoin
3) Aminoglycosides used with great caution