++
Consider the NSAID tiaprofenic acid as a cause of non-infective cystitis.
++
Basic management of urinary tract infection
-
urine dipstick
-
microculture (clean catch): significant levels
-
first line antibiotics—trimethoprim or cephalexin
-
alkaliniser for severe dysuria
-
high fluid intake
-
check sensitivity—leave or changes ABs
-
repeat MCU 7–10 d after AB course
-
consider further investigation
++
-
Treat all patients with symptomatic urinary infection.
-
Treat these asymptomatic patients with bacterial UTI: neonates, preschool children, pregnant women, all those with known or presumed urinary tract abnormality and/or renal impairment, men <60 yrs.
++
Optimal treatment includes:
++
-
high fluid intake
-
complete bladder emptying, esp. at bedtime or after intercourse (women)
-
urinary alkalinisation for severe dysuria (e.g. sodium citrotartrate 4 g orally 6 hrly)
+++
Acute uncomplicated cystitis
+++
Antimicrobial regimen
++
Multiple dose therapy preferred.
++
+++
Multiple dose therapy (based on non-pregnant women)—preferred to single dose
++
++
Follow-up: MSU 7 d later. Avoid using important quinolones—norfloxacin or ciprofloxacin—as first-line agents
++
All adult men with a UTI should be investigated to exclude an underlying abnormality, e.g. prostatitis, obstruction.
+++
Acute cystitis in children >12 mths
++
Treatment should be continued for 5 d:
++
-
trimethoprim 4 mg/kg (up to 150 mg) bd (suspension is 50 mg/5 mL) or
-
cephalexin 12.5 mg/kg (up to 500 mg) bd or
-
amoxycillin clavulanate 12.5/3.1 mg/kg (up to 500/125 mg) (o) bd
++
Norfloxacin is contraindicated in children.
++
+++
Urinary infections in pregnancy
++
Acute cystitis is treated for 10 d with any of the following antimicrobials: cephalexin, amoxycillin/potassium clavulanate or nitrofurantoin (if a beta-lactam antibiotic is contraindicated). The dosages are the same as for other groups. Asymptomatic bacteruria should be treated with a week-long course.
+++
Urinary infections in the elderly
++
Treat uncomplicated symptomatic infections as for adults but not asymptomatic bacteruria.
++
Mild cases: oral therapy (as for cystitis) but double dose except trimethoprim (same dose)
++
++
-
admit to hospital
-
take urine for MCU and blood for culture
-
amoxycillin 2 g IV 6 hrly plus
-
gentamicin 4–6 mg/kg IV daily for 2–5 d then use oral therapy ASAP (total 14 d treatment)
++
Investigate all for an underlying LUT abnormality.
+++
Treatment of recurrent or chronic UTI
++
++
-
amoxycillin/potassium clavulanate (500/125 mg) (o) 12 hrly or
-
trimethoprim 300 mg (o) once daily or
-
norfloxacin 400 mg (o) 12 hrly (if proven resistance to above agents)
+++
Prophylaxis for recurrent UTI
++
In some female patients a single dose of a suitable agent after intercourse is adequate but, in more severe cases, courses may be taken for 6 months or on occasions longer:
++
-
nitrofurantoin (macrocrystals) 50–100 mg (o) nocte or
-
trimethoprim 150 mg (o) nocte or
-
cephalexin 250 mg (o) nocte
++
Children use the same antibiotics according to age.
++
Note: Cranberry products (juice or tablets) may reduce incidence of symptomatic UTI in women but the evidence is not strong.
+++
Indications for investigation of UTI
++
-
All infants and children
-
All males
-
All women with:
+++
Investigations for recurrent UTI
++
Basic investigations include:
++
-
MSU–microscopy and culture (post–treatment)
-
renal function tests: plasma urea and creatinine, GFR
-
intravenous urogram (IVU), and/or US
++
++
-
in children: micturating cystogram
-
in adult males: consider prostatic infection studies if IVU normal
-
in severe pyelonephritis: ultrasound or IVU (urgent) to exclude obstruction
-
in pregnant women: US to exclude obstruction