| ID | 138 |
|---|---|
| Name | ACUTE URINARY TRACT INFECTION (U.T.I) OR ACUTE PYELONEPHRITIS |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: 1. Blood: complete blood count (CBC)- leukocytosis with increased polymorphs. 2. Blood urea, creatinine & electrolytes- should be done in infants & children, and adults with recurrent UTI- urea & creatinine may increase. 3. Urine: routine & microscopic exam- turbid coloured, acidic urine, small amount of albumin with plenty of pus cells are present. 4. Urine culture (MSU)- may show organisms. 5. Ultrasonography of renal system- to exclude any obstructive or parenchymal lesion. |
| Management | Management: 1. General measure: i. Bed rest ii. Plenty of fluid by mouth, at least 2 litres/day. iii. Voiding & regular emptying of bladder at 3-hour intervals till sleeping. iv. If urine is acidic, give alkali mixture 1 oz. 3 times daily to prevent bacterial growth. 2. Antibiotic treatment: It is better to start antibiotic after receiving C/S report of urine, but if the patient is in discomfort empirical treatment should be started immediately after sending the sample of urine for C/S. If then C/S report is available adjust antibiotic accordingly. Cystitis & uncomplicated UTI: First choice: Trimethoprim 200mg 12-hourly; 3 days in women, 10 days in men. Second choices: Amoxicillin 250mg 8-hourly; 3 days in women, 10 days in men. Nitrofurantoin 50mg 6-hourly; 3 days in women, 10 days in men. Cephalexin 250mg 6-hourly; 3 days in women, 10 days in men. Ciprofloxacin 100mg 12-hourly; 3 days in women, 10 days in men. Co-amoxiclav 250/1 25mg 8-hourly; 3 days in women, 10 days in men. In pregnancy: Cephalexin 250mg 6-hourly for 7 days. Amoxicillin 250mg 8-hourly for 7 days. (Avoid trimethoprim and quinolones) Prophylactic therapy: First choice: Trimethoprim 100mg at night; continuous (as advised). Second choices: Nitrofurantoin 50mg at night; continuous (as advised). Co-amoxiclav 250/125mg at night; continuous (as advised). Pyelonephritis & complicated UTI: First choice: Co-amoxiclav 500/125mg 8-hourly for 10 days. Ciprofloxacin 500mg 12-hourly for 10 days. Second choices: (In seriously ill patients start i.v treatment with-) Cefuroxime 750mg i.v 8-hourly for 7-14 days. Gentamicin 80mg (or 3-5mg/kg) i.v 8 hourly for 7-14 days, (in case of renal failure, doses should be determined by plasma creatinine clearence) Acute pros tatitis: First choice: Trimethoprim 200mg 12-hourly for 28 days. Second choice: Ciprofloxacin 500mg 12-hourly for 28 days. Epididymo-orchitis: First choice: Ciprofloxacin 500mg 12-hourly for 14 days. Second choice: Consider screening and treatment for chlamydia in young men. 3. Urine culture should be repeated during treatment and also follow-up urine culture should be done for several weeks after completion of treatment. 4. Prophylactic measures to be adopted by women with recurrent UTI2: i. Adequate fluid intake, atleast 2 litres/day. ii. Regular emptying of bladder (3-hour interval by day & before retiring) iii. Emptying bladder before and after intercourse, iv. Before retiring at night, try to empty bladder twice at 10-15 minutes interval if reflux is present. |
| Introduction | Usually, the urinary tract and the kidneys are sterile when the body defence mechanisms are intact. Acute urinary tract infection is defined when mere is bacterial infection with multiplication in the urinary tract, leading o inflammatory disease of the kidney & renal pelvis, often associated sritis. Gram negative bacteria are the commonest organisms 4mg urinary tract infection, which include- E. coli (90%), proteus, klebsieua, enterobacter, and pseudomonas. gram-positive bacteria are less commonly seen, which may include enterococcus faecalis and staphylococcus aureus. UTI is an ascending type of infection from lower tract to upward except staphylococcus aureus, which usually follows a systemic route. The common source of ascending infection is the faecal contamination, about 75% of E.coli infections are derived from this source. UTI is more common in women than in men. According to pathogenesis UIT may be- i. uncomplicated or ii. complicated. Uncomplicated UTI is mostly due to a single strain of organism, in which urinary tract remains intact anatomically and functionally. Complicated UTI usually involve more than one strain of organism with disruption of structural integrity of urinary tract and defence mechanism. Complicated UTI may result in permanent renal damage. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: Symptoms: 1. Sudden onset of pain in one or both loins radiating to the iliac fossa or suprapubic area. 2. Dysurea, strangury with frequency of micturition. 3. Rapid rise of temperature (38-40°C) with chill, rigor and vomiting. Signs: 1. Spiky temperature, tachycardia, 2. Tenderness over renal angle & suprapubic region. |
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| Treatment | |
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