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