Urinary Tract Infections
		Difference in Signs and Symptoms between Acute Cystitis and Pyelonephritis
		Signs and Symptoms			Cystitis		Pyelonephritis
		Fever			Absent		Usually present
		Urinary urgency/frequency			Present		Sometimes present
		Flank pain			Absent		Sometimes present
		Vomiting			Absent		Often present
		Pyuria			Always present		Always present
		Bacteriuria			Always present		Always present
		Positive blood cultures			Absent		Often present
		Important to determine between acute cystitis and pyelonephritis
		Treatment
		Acute Uncomplicated Cystitis
		Single dose therapy not recommended anymore
		Three day therapy favored in uncomplicated cases
		Treatment with either Ciprofloxacin 250-500mg bid or Bactrim DS bid for three days
		Patients with severe dysuria: Phenazopyridine 200mg tid for 1-2 days is recommended
		Acute Complicated Cystitis
		Considered complicated if one or more of the following exist: male sex, elderly, hospital-acquired, indwelling urinary catheter, pregnancy, structural abnormality of urinary tract, functional abnormality of urinary tract, recent UTI, symptoms persist more than 7 days, recent antibiotic use, immunocompromised, or diabetes mellitus
		Treatment with either Ciprofloxacin 250-500 bid or Bactrim DS bid for 7-14 days
		Acute Pyelonephritis
		Hospitalization recommended if patient has any of the following features
		Diagnosis of acute pyelonephritis uncertain, non-compliance with treatment, inability to maintain oral hydration or take oral medications, presents with severe illness, or pregnancy
		Treatment with IV antibiotics initially for hospital-bound patients is recommended
		Enterococcus concern: treat with ampicillin+gentamicin or zosyn initially
		Enterococcus not a concern: treat with ceftriaxone or aminoglycoside initially
		then switch to oral medication, usually ciprofloxacin 250-500mg bid for 14 days
		Special Considerations/Conditions
		Nosocomial Pyelonephritis
		usually occurs in debilitated patients and often have higher rates of drug resistance
		treat with ceftriaxone with gentamicin for 14 days initially
		if ineffective, treat according to blood cultures
		Recurrent Infections
		defined as more than three infections per year
		treatment is either prophylatic bactrim SS or nitrofurantion daily for about 6 months
		recommend voiding after intercourse to reduce infection rate
		Fungal Infections
		Treat if patient is symptomatic/febrile or immunocompromised
		Treat with fluconazole 100mg daily for 7 days
		Pregnancy
		Treat with cephalexin 250-500mg qid for 7 days
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