Key Messages About Bacterial UTI ( Uncomplicated )
The diagnosis of a urinary tract infection ( UTI ) is primarily based on symptoms and signs .
• Urine testing may contribute additional information towards management but rarely does testing that suggests or proves the presence of bacteria or white cells in the urine have important implications . Diagnosis should be guided by symptoms .
• In elderly patients , asymptomatic bacteriuria is common and there is evidence that treatment is more harmful than beneficial .
• Indirect indicators of the presence of bacteria are likely to be much less valuable than urine culture .
Management of UTI in Adult Women
Diagnosis
• If dysuria , frequent voiding of small volumes , and urinary urgency then probability of infection increases 10-fold to 50 percent . Therefore , presentation of one or more symptoms may be viewed as a valuable diagnostic test in itself .
• New onset of frequency and dysuria with absence of vaginal discharge or irritation has a positive predictive value of 90 percent for UTI .
• In women with symptoms of vaginal itching or discharge , explore alternative diagnoses and consider pelvic examination .
• The presence of back pain or fever increases the probability of upper urinary tract infection . Empirical treatment with an antibiotic should be started ( see antibiotic choices on page 5 ) and a urine culture should be performed to guide the choice of antibiotic .
• Patients with persistent symptoms after 48-72 hours of treatment should undergo radiologic evaluation of the upper urinary tract .
• If a woman remains symptomatic after a single course of treatment , she should be investigated for other potential causes .
Antibiotic Treatment Choosing an antibiotic depends on the agent ' s effectiveness , risks of adverse effects , and resistance rates .
Asymptomatic and Symptomatic Bacteriuria in Pregnant Women
• Treat with antibiotics :
Symptomatic Bacteriuria , Lower Urinary Tract Infection
• Non-pregnant women of any age with symptoms or signs of acute cystitis should be treated with trimethoprim-sulfamethoxazole for 3 days , or nitrofurantoin for 5 days .
• Women with lower urinary tract infection who are prescribed nitrofurantoin should be advised not to take alkalinizing agents such as potassium citrate .
• Women with renal impairment should not be treated with nitrofurantoin because an effective concentration of the antibiotic in the urine is not achievable and a toxic concentration of antibiotic can occur in the plasma .
• Patients who do not respond to trimethoprim or nitrofurantoin should have a urine culture performed to guide the change of antibiotic .
Pyelonephritis , Upper Urinary Tract Infection
• Non-pregnant women with symptoms or signs of acute upper urinary tract infection should be treated with ciprofloxacin 500mg orally for 7 days or trimethoprim-sulfamethoxazole DS one tab every 12 hours for 14 days .
• Urine should be taken for culture before immediate empirical treatment is started and treatment changed if there is an inadequate response .
Asymptomatic Bacteriuria
• Non-pregnant women and elderly women ( over 65 years of age ) with asymptomatic bacteriuria should not receive antibiotic treatment .
� Pregnant women with asymptomatic polyuria or bacteriuria should be treated aggressively as preterm labor can be precipitated , treat with nitrofurantoin or alternate treatment cephalosporin or amoxicillin for 7 to 10 days and obtain urine culture .
Management of UTI in Adult Men
� Because UTIs are atypical in males , prostatitis and sexually transmitted infections must be considered
� UTIs are uncommon in men due to the longer length and narrower caliber of the male urethra .
• UTIs in men are considered complicated and , therefore , cultures are generally indicated even in equivocal cases ( such as trace leukocytes or just trace blood ).
• In sexually active men , urethral swabs for Neisseria gonorrhea and Chlamydia trachomatis or nucleic acid amplification test ( NAAT ) via urine sample should be considered when urethritis is the predominant symptom .
� Males with prostatitis will generally present as a febrile UTI with pain reported in the abdomen , perineum , or rectum . They may also present with chills , myalgias or vomiting . Severe cases with change in mentation , sepsis should be considered .
� In older males may see urinary retention .
UTI - 3