Common UTIs and treatment.

1. URINARY TRACT INFECTIONS
BY: MAGOBA CHRISTINE, BSN
&
KASADHA NASSER BSc, MSc
24/8/2023
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2. Outline
1. Definition
2. Classification
3. Causes
4. Risk factors
5. Clinical manifestations
6. Management
7. Prevention
Definition: UTIs are defined as Infection of any part
of the urinary tract
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3. Classification and examples
• Upper UT: Kidneys, and ureters
• Lower UT: Bladder, and urethra
• Upper UTI: acute pyleronephritis
• Lower UTI: Cystitis, Urethritis
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4. Classification Cont’
• Can be complicated or uncomplicated
• Uncomplicated; normal renal tract structural
and function.
• Complicated; structural/functional
abnormality of GUS e.g. obstruction, stones
and abscess formation
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5. CAUSATIVE AGENTS
Usually anaerobes and gram negatives from bowel
and vaginal flora.
Gram negatives:
• E. coli main cause in community 75-95%
• Klebsiella
• Proteus mirabilis
• Enterococci
Gram positives:
• Staphylococcus
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6. RISK FACTORS
• History of recent UTI
• Use of diaphragm
• Use of spermicide
• Indwelling urethral
catheters
• Dehydration
• Obstructed UT
• Urinary incontinence
• Faecal incontinence
• Increased sexual activity
Increased bacterial over
growth
• DM
• Immunosuppression
• Obstruction
• Stones
• Catheter
• Pregnancy
• Old age
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7. Risk factors cont’
NB
UTIs common in women due to;
• Short urethra
• Close proximity of anal opening with urethral
opening.
Males are protected due to;
• Long urethra
• Prostate secretions(bacteriostastic)
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8. CLINICAL MANIFESTATION
SYMPTOMS:
LOWER UTI
Cystitis;
• Increased urinary frequency
• Dysuria
• Urgency
• Suprapubic pain
• Polyuria
• Hematuria
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9. CLINICAL MANIFESTATIONS cont’
UPPER UTI:
ACUTE PYELONEPHRITIS;
• Fever
• Rigors
• Vomiting and nausea
• Loin pain, lower abdominal pain
• Associated cystitis symptoms
• Septic shock
• Foul smelling urine
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10. CLINICAL MANIFESTATION cont’
Signs:
• Fever
• Supra pubic tenderness
• loin tenderness
• Examine for distended urinary bladder
• Examine for prostate enlargement
• Renal angle tenderness
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11. INVESTIGATIONS/DIAGNOSIS
Urinalysis:
Urine dipstick;
• WBC and nitrites suggest UTI
• Do not use urine from the catheter or urine
bag, sample collection technique?
Urine microscopy; pus cells, how many? ≥ 5
per HPF
Urine culture; mid stream urine
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12. Cont’
Blood tests: if systemically unwell;
FBC,
Blood culture in case of failure to respond to treatment
Electrolytes panel
RFTs
Imaging :
USS; kidneys, prostate
Cystoscopy, CT
Intravenous urography: persistent upper UTI, recurrent
UTI(>2 years), persistent hematuria and obstractive
uropathies
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13. Diagnosis
• Symptoms + or – leucocytes and or nitrates at
urine analysis
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14. TREATMENT
Cystitis
Ensure high fluid intake
First line; tabs nitrofurantoin 100mg 12hourly for
5-7 days.
Trimethoprim sulfamethoxazole 160/800 g 12
hrly for 3 days
Fosfomycin tremetamol 3 g once for one day
2nd line; tabs ciprofloxacin 500mg 12hourly5-
7days
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15. TREATMENT CONT’
• Levofloxacin 250-500 mg daily for 3 days
• Alternative agents
• Cephalexin 500 mg 6-12 hrly for 7 days
• Amoxicillin/clavulanate 500/125 mg every 12
hrs for 3 days
• Cefpodoxime 100 mg every 12 hrs for 3 days
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16. TREATMENT CONT’
Pyelonephritis
• Ensure adequate fluid intake
• PCM 1g 8hrly, for pain & fever
Hospitalised
• Ampicillin 1 g 6 hours, plus gentamycin 1
mg/kg every 8 hrs IV for 14 days
• Ceftriaxone 1 g daily for 14 days
• Ciprofloxacin 12hrly 400mg for 14 days
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17. Cont’
Non hospitalized
• Ceftriaxone 1 g once
• Ciprofloxacin 400 mg once
• Gentamycin 5mg/kg
Followed by
• Ciprofloxacin 500 mg 12 hrly for 7 days Or
• Levofloxacin 750 mg daily for 5 days
• Trimethoprim-sulfamethoxazole 160/800 mg one
tablet every 12 hrs for 14 days
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18. Acute bacterial prostatitis
Hospitalized
• Ampicillin 2 g every 6 hrs plus gentamycin 1.5
mg/kg every 8 hrs IV until afebrile
• Followed by one of these
• Trimethoprim-sulfamethoxazole 160/800 mg ever
12 hrs for 3 weeks
• Ciprofloxacin 250-500 mg every 12 hrs for 3
weeks
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19. Chronic prostitis
First line
• Ciprofloxacin 500 mg every 12 hrs for 1-3 months
• Levofloxacin 750 mg daily for 28 days
Second line
• Doxycline 100 mg twice daily for 4-12 weeks
• Azithromycin 500 mg daily for 4-12 weeks
• Clarithromycin 500 mg daily for 4-12 weeks
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20. COMPLICATIONS
• Renal calculi
• Peri-nephric abscess
• Septic shock
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21. PREVENTION
• Improving perineal hygiene
• Taking plenty of fluids
• Completely empting the bladder frequently
• Avoid bad vaginal practices like vaginal
steaming, dounching, application scents,
herbal medicines etc
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22. DIFFERENTIAL DIAGNOSIS
• Vulvovaginitis
• Gonococcal and non-gonococcal urethritis
• Bladder tumor
• Chemical induced cystitis
• Drug induced cystitis
• Cholecystitis
• Salpingitis
• appendicitis
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