Urinary tract infection, in pregnancy *New*
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition
CYSTITIS
ICD-10 code: 023.1
DESCRIPTION
This condition usually presents with lower abdominal pain, frequency of micturition and/or dysuria. There are no features of sepsis, e.g. fever.
Urine dipstick testing usually shows nitrites and/or leukocytes; protein and/or blood may also be detected.
GENERAL MEASURES
- Encourage oral fluid intake.
- Midstream urine for microscopy, culture and sensitivity (start empiric treatment while awaiting results).
MEDICINE TREATMENT
See: Urinary tract infection.
REFERRAL
- No response to treatment, or resistant organism on culture.
- Features of pyelonephritis (See: Pyelonephritis, below).
PYELONEPHRITIS
ICD-10 code: O23.0
DESCRIPTION
Features of pyelonephritis include: temperature ≥38°C, renal angle tenderness, vomiting, tachypnoea, tachycardia, hypotension, confusion.
This condition is more serious and may result in preterm labour.
GENERAL MEASURES
- Collect midstream urine for microscopy and culture and sensitivity.
- Ensure adequate hydration with IV fluids while awaiting transfer.
MEDICINE TREATMENT
Empiric therapy:
- Ceftriaxone, IV, 1 g as a single dose.
CAUTION: USE OF CEFTRIAXONE
Do not administer calcium-containing fluids, e.g. Ringer-Lactate, concurrently with ceftriaxone.
LoE:IVb
REFERRAL
All cases.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare Level, Updated for the 2023 Edition