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21.4 Urinary Tract Infection (UTI)

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Urinary tract infections may involve the upper or lower urinary tract. Infections may be complicated or uncomplicated. Uncomplicated cystitis is a lower UTI in a non-pregnant woman of reproductive age and who has a normal urinary tract. All other UTIs should be regarded as complicated.

Differentiation of upper from lower urinary tract infection in young children is not possible on clinical grounds
Upper UTI is a more serious condition and requires longer and sometimes

intravenous treatment. To be summarized and refined; see also Obstetric/Gynecology

Diagnostic criteria of upper UTI (pyelonephritis)

  • Flank pain/tenderness
  • Temperature 380C or higher
  • Tachypnoea, tachycardia, confusion, and, hypotension
  • Vomiting


  • urine microscopy, culture and sensitivity
  • Ultrasound (kidney and pelvis)to exclude stones and structural abnormalities

Non-Pharmacological Treatment

  • Ensure adequate hydration

Pharmacological Treatment

Acute pyelonephritis

A: Ciprofloxacin 500 mg (PO) 12 hourly for 7 days

Uncomplicated cystitis


A: Ciprofloxacin 500 mg (PO) as single dose Complicated cystitis Adults:

A: Ciprofloxacin 500 mg (PO) 12 hourly for 7 days For pregnant women and adolescents:

C: Amoxicillin/clavulanic acid 500/125 mg (PO) 12 hourly for 7 days

Acute Pyelonephritis

Outpatient therapy is only indicated for women of reproductive age, who do not have any of the danger signs – see referral criteria. All other patients should be referred.

A: Ciprofloxacin 500 mg (PO) 12 hourly for 10 days


Refer the patient urgently to the next facility with adequate expertise and facilities if:

Acute pyelonephritis with:

  • Vomiting
  • Sepsis
  • Diabetes mellitus

Acute pyelonephritis in:

  • Pregnant women
  • Women beyond reproductive age
  • Men

While patients Awaiting Transfer

Ensure adequate hydration with intravenous fluids

A: Ceftriaxone IM, 50–80 mg/kg/dose immediately as a single dose


  • All children for urinary tract investigations after completion of treatment
  • No response to treatment.
  • UTI more than 3 times within a one-year period in women, and more than 1 time for men

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