Urinary Tract Infections In Adults

Urinary Tract Infections in Adults

    Urine culture and antibiotic sensitivity Test (ABST) should be performed except in non pregnant women with acute cystitis. Treat initially with following antibiotics until culture and ABST are available and change antibiotics if necessary.

    Urinary tract infection (UTI) is considered when urine culture yields siginificant concentration of uropathogenic bacteria. Patients with bacteria infection usually have bacterie > 105 cfu/mL. However symptomatic UTI or partially treated UTI should be considered when culture shows bacteria 103 - 105 CFU/mL.

    Commonly isolated organisms include: 

Escherichia coli, Klebsiella spp., Enterococci, Proteus mirabilis, pseudomanas aeruginosa, Staphylococcus saprophyticus.

Klebsiella spp

Enterococci

 pseudomanas aeruginosa

Proteus mirabilis

staphylococcus saprophyticus

Escherichia coli

01. Acute cystitis (Inflammation in the badder) 

Acute cystitis is a sudden inflammation of the bladder. Most of the time, a bacterial infection causes it. This infection is commonly referred to as a urinary tract infection (UTI). Irritating hygiene products, a complication of certain diseases, or a reaction to certain drugs can also cause acute cystitis.
More troublesome symptoms of cystitis are most commonly caused by a bacterial infection. This can occur when bacteria travels from the anus up the urethra, reaching the bladder and causing an infection. The most common reasons for this are personal hygiene habits.
Urine culture and antibiotic sensitivity Test (ABST) should be performed except in non pregnant women with acute cystitis.

Treating cystitis at home

1. drinking lots of water.
2. taking over-the-counter painkillers such as ibuprofen and paracetamol.
3. refraining from sex.
4. soothing your discomfort with a hot water bottle.
5. avoiding alcohol, fruit juice and caffeine.

What is honeymoon cystitis?

Honeymoon cystitis (or "honeymoon disease") is cystitis caused by sexual activity. The symptoms are the same as with cystitis triggered by something other than sex: burning sensation when peeing as well as the frequent urge to go to the bathroom.
acute uncomplicated cystitis in adults:

Treated with Oral, 

• Cefalexin 500 mg 8 hourly for 3 days or,
• Nitrofurantoin 100 mg 12 hourly or, 50 mg 6 hourly five days
• Nalidixic acid 500 mg 6 hourly for five days or,
• Co-trimoxazole 960 mg 12 hourly for 3 days or,
• Co-amoxiclav 625 mg 8 hourly for 3 days.

Since amoxicillin resistance is high it should not be used unless susceptibility is known. Fluroauinolones (ciprofloxacin, ofloxacin, norfloxacin) should not be used as frontline therapy. Single dose therapy is not recommended. 

An example of a single dose for example wis a women who may develop a mild to moderate vaginal yeast infection. The treatment for this can be in several forms. One of the way to treat is fluconazol 150mg tablet which is an anti-fungal medication. The standard dose is one table one time as a single dose which will usually take care of this infection with followup with a primary care giver if there are continual complications.

For acute cystitis in pregnant women the recommended duration of treatment is 7 days.

In pregnancy co-trimoxaazole is best avoided and furoquinolones are contraindicated.

Recurrent Cystitis ( . Recurrent cystitis is a term use to describe repeated bladder infections)

It is an inflammation of the bladder that occurs three times or more in one year. These patients should be referred to a general physician to exclude underline abnormalities. 

After treating the acute infection, prophylactic treatment should be continued with oral 

• Cephalexin 250 mg daily at night or,
• Nitrofurantoin 50 mg daily at night or,
• Co-trimoxazole 960mg daily at night.

Continue for 3 to 6 months or longer in some patients.

If related to coitus (sexual intercourse) give oral single dose post-coital prophylaxis with:

• Cephalexin 500mg or,
• Co-trimoxazole 960 mg or,
• Nitrofurantoin 100 mg.

Women whose recurrent UTIs are associated with sexual intercourse should be offered postcoital prophylaxis. This involves taking a single dose of an effective antimicrobial (eg, nitrofurantoin 50 mg, trimethoprim-sulfamethoxazole [TMP-SMX] 40/200 mg, or cephalexin 500 mg) after sexual intercourse.


02. Acute Pyelonephritis

Acute pyelonephritis is a potentially organ- and/or life-threatening infection that often leads to renal scarring. Acute pyelonephritis results from bacterial invasion of the renal parenchyma. Bacteria usually reach the kidney by ascending from the lower urinary tract.

How long do you treat pyelonephritis?

Twelve percent returned with persistent symptoms, most in the first day; most of these were admitted. Acute pyelonephritis has customarily been treated with 14 days of antibiotics, and 2010 IDSA guidelines maintain this recommendation for TMP-SMZ and beta-lactam agents.

What is the cause of acute pyelonephritis?

From there, the bacteria travel through the ureters to the kidneys. Bacteria such as E. coli often cause the infection. However, any serious infection in the bloodstream can also spread to the kidneys and cause acute pyelonephritis.

What is the best treatment for pyelonephritis?

Treatment options for women with acute pyelonephritis not requiring hospitalization include 500 mg of oral ciprofloxacin (Cipro) twice per day for seven days; 1,000 mg of extended-release ciprofloxacin once per day for seven days; or 750 mg oflevofloxacin (Levaquin) once per day for five days.

A urine culture ABST should always be done.

Adults
Start treatment with

• Gentamicin 4 - 6 mg/kg IV single dose

Children

Start treatment with 

• Gentamicin 2.5 mg/kg IV single dose and refer patient to a hospital where speciaist services ae available.

Fo asymptomatic bacteria in children without genito urinary abnormalities, in elderly men and women treatment is not required.