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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.

Note:
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

Investigations

  • 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

Adults:

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

Referral

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

Non-urgent

  • 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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