Urinary Tract Infection

INTRODUCTION

Treatment

• 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

Treatment (non-pregnant women)

• Trimethoprim 300 mg (o) d for 3 d or

• Cephalexin 500 mg (o) bd for 5 d or

• Amoxicillin + clavulanate 500/125 mg (o) bd for 5 d or

• Nitrofurantoin 100 mg (o) qid for 5 days or

• Norfloxacin 400 mg (o) bd for 3 d (if resistance to above agents proven and if susceptible, caution with tendon rupture)

No follow-up is required if women remain asymptomatic after treatment.

Acute cystitis in children > 12 mths

Treatment should be continued for 3–7 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

• trimethoprim/sulfamethoxazole 4/20 mg/kg (max. 160/800 mg) (o) bd

Amoxicillin, amoxicillin/clavulanate, norfloxacin or ciprofloxacin may be required based on pathogen susceptibility.

Repeat urine test is not required if children remain asymptomatic after treatment.

Urinary infections in pregnancy Acute cystitis is treated for 5 d with any of the following antimicrobials: cephalexin, amoxicillin/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. Repeat urine test 1–2 wks after completion.

Urinary infections in adult males

• Investigate all men for underlying abnormality, e.g. prostatitis, obstruction

• Treat with the same antibiotics as for non-pregnant women, however, for 7 days

Urinary infections in the elderly Treat uncomplicated symptomatic infections as for adults but not asymptomatic bacteruria.

ACUTE PYELONEPHRITIS

Mild cases: amoxicillin/clavulanate 875/125 mg (o) bd for 10–14 d or ciprofloxacin 500 mg (o) bd for 7 d. Modify empirical therapy based on culture and susceptibility results.

Severe:

• admit to hospital

• take urine for MCU and blood for culture

• amoxicillin 2 g IV 6 hrly plus

• gentamicin 4–6 mg/kg IV daily for 2–5 d, follow with oral therapy for a total of 14 d

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