Urinary Tract Infections

Other than mild cystitis, MSU culture before starting abx if possible. Consider blood cultures if pyrexic and unwell with NV (suspect sepsis). In men, consider urology review (congenital malformations) if recurrent. Nitrates in urine has a very poor sensitivity (<50%). Consider risk of trimethoprim in women of childbearing age! Cranberry products reduce symptoms but do not resolve UTI!

Cystitis: Dysuria, Polyuria, Urgency, Nocturia, Cloudy, Urine, WBC & RBC.

• .Trimethoprim 300mg po sid 3/7.
• If pregnant, or Trimethoprim doesnt work, use Cephalexin 500mg po sid 5/7.
• Resistant to all, then Norfloxacin 400mg po BD 3/7.

Pyelonephritis: NV, 38C+, abdo/flank pain, white cells, MCS+.
For mild cases (low fever, no sepsis, no vomiting), treat as per cystitis - trimethoprim then norfloxacin. If septic, give Gentamicin 6mg/kg iv stat PLUS Amoxycillin 2g iv qid. Repeat in 24h if eGFR > 60. If low eGFR, liase ID reg. Max 3 doses genta.

Recurrent UTI: Tx as per pyelonephritis.

• Women: Trimethoprim 150mg po nocte up to 6/12 as prophylaxis; review if still recurrent. Consider pre-intercourse stat doses. Consider self administer trimethoprim 300mg 3/7 regime, with instructions to seek help when not resolved in 2/7.
• Men: Consider prostatitis if symptoms include lower back / perineal pain, painful ejaculation. Ix DRE prostate.