Table One : Summary Information for UTI Treatment in Adults
Recurrent ( Uncomplicated ) UTIs in Women |
Management of Bacterial UTI in Pregnant Women |
Management of Bacterial UTI in Adult Men |
Management of Bacterial UTI in Patients with Catheters |
Diagnosis |
Recurrent UTIs are common among women , even though they have anatomically and physiologically normal urinary tracts . |
• Standard quantitative urine culture should be performed routinely at the first antenatal visit .
• The presence of bacteria in urine should be confirmed with a second urine culture .
• Dipstick testing should not be used to screen for bacterial UTI at the first or subsequent antenatal visits .
• UTIs in men are generally viewed as complicated because they result from anatomic or functional anomaly of the genito-urinary tract .
• Prostatitis , sexually transmitted diseases ( STDs ) and epididymitis should be considered as possible diagnoses .
• In all men with symptoms of UTI , a urine sample should be taken for culture .
• In men with a history of fever or back pain , the possibility of UUTI should be considered and a urine culture should guide the choice of antibiotic .
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Clinical symptoms or signs are not recommended for predicting the likelihood of symptomatic UTI in catheterized patients .
In catheterized patients who present with fever :
• Look for associated flank or suprapubic tenderness or systemic features .
• Exclude other potential sources of infection .
• Send urine culture to determine organism and susceptibility .
• Consider antibiotic therapy , taking into account the severity of the presentation and any comorbid factors .
Testing :
• Urine samples should only be sent for laboratory culture if the patient has clinical sepsis , not because the appearance or smell of the urine suggests that bacteria are present .
• Laboratory microscopy should not be used to diagnose UTI in catheterized patients .
• Dipstick testing should not be used to diagnose UTI in catheterized patients .
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Antibiotic Treatment
Additional Treatments and Referrals
The following prophylactic regimens are recommended :
• Long-term , low-dose prophylactic antimicrobials taken at bedtime .
• Post-intercourse prophylactic antimicrobials for women in whom episodes of infection are associated with sexual intercourse .
• A patient-initiated treatment in well-informed young women .
Cranberry Products : Women with recurrent UTIs should be advised to take oral cranberry products to reduce the frequency of recurrence . Patients taking warfarin should avoid taking cranberry products unless the health benefits are considered to outweigh any risks .
Methenamine Hippurate : May be used to prevent symptomatic UTI in patients with known upper renal tract abnormalities .
Estrogen : Oral Estrogen Not recommended for routine prevention of recurrent UTIs in postmenopausal women .
Symptomatic Bacteriuria : Pregnant women with symptomatic UTI should be treated with an antibiotic .
Asymptomatic Bacteriuria : If detected during pregnancy , should be treated with an antibiotic .
Screening During Pregnancy : Women with Bacteriuria confirmed by a second urine culture should be treated and have a repeat urine culture at each antenatal visit until delivery .
Not applicable .
Symptomatic Bacteriuria : Bacterial UTI in men should be treated empirically with a 2-week course of quinolone .
Asymptomatic Bacteriuria : Elderly men ( over age 65 ) should not receive antibiotic treatment .
Men should be referred for urological investigation if they :
◦ have symptoms of upper urinary tract infection ,
◦ fail to respond to appropriate antibiotics , or
◦ have recurrent UTIs .
Symptomatic Bacteriuria : 1 . Symptoms that may suggest UTI in patients with catheters Include fever , flank or suprapubic discomfort , change in voiding patterns , nausea , vomiting , malaise , or confusion . 2 . Catheterized patients with symptoms or signs of acute UUTI should be treated with ciprofloxacin or co-amoxiclav for 7 days .
3 . Patients should be admitted to the hospital if systemic symptoms such as fever , chills , vomiting , or confusion appear .
4 . Patients with long-term indwelling catheters should have the catheter changed before starting antibiotic treatment for symptomatic UTI .
Asymptomatic Bacteriuria : 1 . Screening women after short-term catheterization is not recommended . 2 . Catheterized patients should not receive antibiotic treatment .
Not applicable .
UTI - 4