Urinary Tract Infection (UTI)
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Diagnosis
- There may be frequency, dysuria & lower abdominal pain
- Flank or loin pain will be present if there is pyelonephritis
- Central suprapubic tenderness is frequent (tenderness from PID extends away from the midline)
- Renal angle tenderness is usually found only with pyelonephritis
Investigations
- Urine dipsticks usually reveal leukocytes, nitrites, blood, &/or protein.
- Indications for urine MC&S include:
- where the diagnosis is in doubt,
- where the patient is unwell,
- where previous treatment has been unsuccessful – & symptoms persist
- Record that urine MC&S has been requested & arrange follow-up
Management
The well patient may be treated with oral antimicrobials:
Cephalexin (Keflex) 500 –1000 mg four times daily for 5-7 days, or sulphamethoxazole-trimethoprim (Bactrim) two tablets twice daily for 5-7 days, or nitrofurantoin 50-100 mg four times daily for 5-7 days. Resistance of E.coli to amoxicillin is widespread.
The unwell patient requires admission to hospital:
- Take urine for MC&S before starting treatment
- Take blood for U&E & FBC
- Prescribe intravenous antibiotics, followed by oral antibiotics after improvement & discharge from hospital
- Ensure good hydration throughout, treat vomiting with antinausea drugs, e.g. prochlorperazine (Stemetil 12.5 mg IM)
- After clinical improvement, follow-up is unnecessary unless there has been renal impairment or recurrent infection
Intravenous antibiotics for unwell patients with urinary tract infection
First-line drugs (from first choice)
- Kefzol (Cefazolin) 500mg – 1G 8 hourly
- Cephradine (Cefril) 500 – 1 000 mg 6 hourly
- Cefoxitin (Mefoxin) 1 g 8 hourly
- Cefuroxime (Zinacef) 750 mg 8 hourly
- Co-amoxiclav (Augmentin) 1.2 g 8 hourly
- Ceftriaxone (Rocephin) 500 – 1 000 mg mg 12 hourly
- For penicillin-sensitive patients consider trimethoprim/sulphamethoxazole 10 mL (160/800 mg) twice daily, or erythromycin 500 mg 6 hourly
Oral follow-up
Oral follow-up treatment is usually cephalexin 500 mg four times daily, cefuroxime 500 mg twice daily or sulphamethoxazole 2 tablets twice daily, all for 5-7 days.