Urinary tract infection
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)