Neobook — clinical reference

N10/N30.9/N39.0/O23.4

DESCRIPTION

UTIs include cystitis (infection of the bladder/lower urinary tract) and pyelonephritis (infection of the kidney/upper urinary tract). Pyelonephritis develops when pathogens ascend to the kidneys via the ureters. Uncomplicated UTIs involve either the lower urinary tract (bladder) and/or the upper urinary tract (kidney) in non-pregnant, pre-menopausal woman with no known relevant anatomical and/or functional abnormalities within the urinary tract or any comorbidities. UTIs in other groups of patients are complicated by definition.

Features of upper UTI include:

flank pain/tenderness
temperature >38^ºC
other features of sepsis, i.e. tachypnoea, tachycardia, confusion and hypotension, or
nausea and vomiting.

In complicated, recurrent or upper UTIs, mid-stream urine should be sent for microscopy, culture and sensitivity.

MEDICINE TREATMENT

Women with recurrent UTIs should be advised to:

void bladder after intercourse and before retiring at night
not postpone voiding when urge to micturate occurs
change from use of diaphragm to an alternative type of contraception

Empirical treatment is indicated only if:

positive leucocytes and nitrites on urine test strips on freshly passed urine,
or
leucocytes or nitrites with symptoms of UTI, or
systemic signs and symptoms indicating an upper UTI and/or urosepsis.

Note:

Alkalinising agents are not recommended, as many antibiotics require a lower urinary pH.

Uncomplicated community acquired cystitis N30.9

Fosfomycin, oral, 3 g as a single dose.

LoE:IIb^xxix

Gentamicin, IM, 5 mg/kg as a single dose.

Note:

Gentamicin should not be used in renal impairment or pregnancy (see Appendix II: Prescribing Information for Specific Medicines for guidance on prescribing). Therapeutic drug monitoring is not required.

LoE:IIb^xxx

Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.

LoE:IIb^xxxi

Complicated community acquired cystitis (Non-pregnant women) N30.9

Ciprofloxacin, oral, 500 mg 12 hourly for 7-10 days.

LoE:IIb^xxxii

CAUTION

Concomitant use of fluoroquinolones with ACE-inhibitor/angiotensin receptor blocker is contraindicated in moderate to severe renal impairment (eGFR ≤ 30 ml/min/1.73m² ) and in the elderly. Assess renal function before initiating treatment and monitor during treatment. Evidence suggests a risk of developing acute kidney injury with concomitant use of fluoroquinolones and renin-angiotensin receptor blockers.

LoE:IIb^xxxiii

For pregnant women: O23.4

Fosfomycin, oral, 3 g as a single dose.

LoE:IIb^xxxiv

Nitrofurantoin, oral, 100 mg 6 hourly for 5 days.

LoE:IIb^xxxv

Acute pyelonephritis N10

Admit all patients with vomiting, sepsis, diabetes or impaired/worsened renal function (eGFR <60 mL/min/1.73m2 ).
Ensure adequate hydration with intravenous fluids.
If there is a poor response, perform an ultrasound on all hospitalised patients urgently as in-patients.
Adjust antibiotic according to sensitivity.
Duration of antibiotic therapy in uncomplicated pyelonephritis:

Fluoroquinolones: 7 days
Other antibiotics: 14 days.

Longer courses of therapy, 2–3 weeks, should be given for complicated pyelonephritis.

Patients who have features of severe sepsis or who are vomiting, initiate IV therapy and switch to oral therapy as soon as clinical condition improves:

If normal renal function:

Gentamicin, IV, 6 mg/kg daily (See Appendix II: Prescribing Information for Specific Medicines for guidance on prescribing and monitoring)

Switch to oral therapy as soon as the patient is able to take oral fluids, according to microscopy culture and sensitivity results:

Ciprofloxacin, oral, 500 mg 12 hourly for 7-10 days.

If impaired renal function:

Ceftriaxone, IV, 1 g daily.

Switch to oral therapy as soon as the patient is able to take oral fluids, according to microscopy culture and sensitivity results:

Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
- If severe renal impairment (eGFR <10 mL/min/1.73m2 ): 50% of normal dose.

REFFERAL/CONSULTATION

Urgent

Acute pyelonephritis in pregnant women.
Acute pyelonephritis with:
- vomiting
- sepsis
- diabetes mellitus
- urinary tract obstruction on ultrasound

Non-urgent

Failure to improve within 72 hours.
Women beyond reproductive age.
>3 uncomplicated UTIs within a one-year period.
>1 complicated UTI within a one-year period.

Click here to access the pdf.

Standard Treatment Guidelines and Essential Medicines List for South Africa, Adult Hospital Level, 2020-2024_Version 1.0_17 October 2024

Chapter 7 Nephrology/Urological Disorders_7.3 Urological Disorders_7.3.2 Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI)

Drugs mentioned

ICD-10 codes