Womens health Flashcards
What bacteria causes a UTI?
E.coli (most common)
others= Klebsiella species, Proteus species, Pseudomonas aeruginosa, and Enterococcus species
Typical symptoms of a UTI
Dysuria- pain, tingling, burning
Increase in frequency and urgency,
Nocturia,
Changes in urine appearance- cloudy, blood present
Suprapubic discomfort
elderly
delirium, lethargy, reduced ability to carry out activities of daily living and anorexia.
How could an elderly patient present with a UTI
delirium, lethargy, reduced ability to carry out activities of daily living and anorexia.
Symptoms of an Upper UTI/ pylenophritis (in addition to lower)
Loin pain
Fever
Symptoms of an Upper UTI/ pylenophritis (in addition to lower)
Loin pain
Fever
Red flag symptoms of a UTI
haematuria, loin pain, rigors (drastic changes in temperature), nausea, vomiting, and altered mental state — consider the possibility of serious illness such as sepsis.
Sepsis NEWS score parameters
Resp rate - 12 - 20
Temperature- 36.1 and 38.0
Heart rate- 51 to 90
Blood pressure (systolic)- 111- 219
Consciousness- alert or not
Oxygen sats- >96
NEWS thresholds
0-4 = low
RED score of 3= medium
5-6= medium
7 or more= high
When can a dipstick be used to aid diagnosis? and what time of day would be most reliable
pt under 65
no symptoms indicating complicated UTI
morning
Which patient groups would a urine dipstick be unreliable?
> 65
catheterised
pregnancy
What would indicate a positive urine dipstick?
positive for nitrite or leukocyte and red blood cells (RBC) UTI is likely.
What patient groups would require sample to be sent for a urine culture?
over 65
pregnancy
persistent symptoms or not resolving
recurrent UTIs- more than 2 in 6 months or 3 in 1 year
Catheterised
risk factors for Complicated uti
what are the risk factors for a complicated UTI?
Abnormalities of genitourinary tract,
renal impairment,
residence in a long term care facility,
hospitalisation for more than 7 days in the last 6 months,
recent travel to a country with increased resistance or previous resistant UTI.
First line UTI treatment for : Females non-complicated
Nitrofurantoin: 100mg MR BD x3 days
Trimethoprim: 200mg BD x3 days
Second line UTI treatment for : Females non-complicated
- Nitrofurantoin 100mg modified-release twice a day for 3 days (if eGFR ≥45ml/minute and not used as first-choice)- if nitro hasn’t been used as first line
or - Pivmecillinam (a penicillin) 400mg initial dose, then 200mg three times a day for a total of 3 days or
- Fosfomycin 3g single dose sachet.
How to treat recurrent UTIs (no haematuria, not pregnant or catheterised)
post menopausal= vaginal oestrogen
if ineffective
prophylaxis abx:
First choice - Trimethoprim 200mg single dose when exposed to a trigger
or
Nitrofurantoin (if eGFR ≥45ml/ minute) 100mg single dose when exposed to a trigger.
Second choice – Amoxicillin 500mg single dose when exposed to a trigger (off label indication)
or
Cefalexin 500mg single dose when exposed to a trigger.
Red flag symptoms UTI in pregnancy
recurrent lower UTI.
catheter associated UTI.
If culture reveals an atypical bacteria.
underlying structural or functional abnormality or co-morbidity which increases the risk of complications or treatment failure.
suspected underlying malignancy or renal disease.
First line UTI treatment for : Females pregnant
Nitrofurantoin (avoid at term) 100mg modified-release twice a day for 7 days if eGFR ≥45ml/minute.
Second line UTI treatment for : Females pregnant
no improvement in lower UTI symptoms on first-choice taken for at least 48 hours or when first-choice not suitable) consider prescribing:
- Amoxicillin (only if culture results available and susceptible- high resistance rates) 500mg three times a day for 7 days.
- Cefalexin 500mg twice a day for 7 days.
When should trimethoprim be avoided?
pregnancy
People with severe hepatic insufficiency, or severe renal insufficiency.
People with megaloblastic anaemia or other blood dyscrasias.
Premature infants or children aged under 4 months.
interacting medication- e.g. methotrexate
Trimethoprim adverse effects
Blood disorders — leucopenia, megaloblastic anaemia, thrombocytopenia, agranulocyctosis, methaemoglobinaemia.
Gastrointestinal — diarrhoea, nausea, vomiting, glossitis.
Nervous system — aseptic meningitis (frequency unknown), headache.
Skin — Pruritus, and skin rashes
Nitrofurantoin contra-indications
Acute porphyria
G6PD deficiency
<3 months
EGFR <45
trimethoprim interactions
Aciclovir — increased risk of nephrotoxicity.
Amitryptiline, carbamazepine, SSRIs, mefanamic acid, NSAIDS— increased risk of hyponatraemia.
ACE inhibitors and angiotensin-II receptor antagonists AIIRAs, diuretics— there may be an increased risk of hyperkalaemia with the concurrent use of these drugs and trimethoprim. Monitor potassium concentrations.
Azathioprine and mercaptopurine — increased risk of haematological toxicity in people who have had a renal transplant. However, the combination is commonly used in practice. Monitor the full blood count routinely.
Ciclosporin — serum creatinine levels may be increased. Possible increased risk of nephrotoxicity. Increased risk of hyperkalaemia. Monitor renal function closely.
Coumarins (warfarin) — the anticoagulant effect of coumarins may be potentiated. Monitor international normalised ratio (INR) and adjust dose accordingly.
Digoxin — digoxin levels may be increased in the elderly if taken with trimethoprim. Monitor for digoxin adverse effects, and adjust dose accordingly.
Methotrexate (a folate antagonist) — there is an increased risk of haematologic adverse effects. Full blood count should be monitored routinely.
Phenytoin – phenytoin levels may be increased if taken with trimethoprim. Monitor phenytoin levels and adjust dose accordingly.
when should Nitrofurantoin be avoided?
<45mL/min
