Urinary tract infection

Risk factors

Risk factors for UTIs in younger women 

Sexual intercourse

Contraceptive diaphragms (especially with spermicides)

 Past history of childhood

Risk factors in postmenopausal women

Urinary incontinence

Cystocele

Atrophic vaginitis

History of UTIs before menopause.

Clinical features

Urinary frequency

Urinary burning

Fever

Abdominal pain- loin/ lower abdominal

Hematuria

Investigation

Urine dipstick

Urine MCS

U/s KUB if recurrent UTI

Other investigations as per age and possible cause of UTI

Treatment choices

Simple UTI should be treated with empirical first-line antibiotic therapy such as trimethoprim 300 mg orally at night for 3 days or cephalexin 500 mg orally twice daily for 5 days

Other options include

Amoxycillin with clavulanate

Nitrofurantoin

For complex UTI— Quinolones

Note 

In pregnant women, trimethoprim is contraindicated so  cephalexin is recommended

Patients with recurrent UTI where other causes, of UTI, have been excluded, can be offered the following options

Continuous prophylaxis

3–6 months  duration of  Trimethoprim 150 mg daily

Cephalexin 250 mg nocte

Nitrofurantoin 50 mg nocte

Trimethoprim + sulphamethoxazole 160/800 mg

Self start therapy

Trimethoprim nocte for 3 days

Cephalexin 500 mg bd for 5 days

Nitrofurantoin 50mg 6 hourly for 3 days

Norfloxacin 400 mg bd for 3 days

Augmentin 500/125 mg bd for 5 days

Post intercourse—stat dose of the above medications

Note

Nitrofurantoin side effects that need to be considered with prolonged therapy

1- Interstitial pulmonary fibrosis

2- Peripheral neuropathy (usually beginning with lower limb paraesthesia)

3 – Hepatotoxicity (chronic active hepatitis)