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
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
Treat with cephalexin 250-500mg qid for 7 days
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