Urinary Tract Infection (UTI) in Females

Signs and symptoms

Dysuria
Urinary urgency and frequency
A sensation of bladder fullness or lower abdominal discomfort
Suprapubic tenderness
Flank pain and costovertebral angle tenderness (may be present in cystitis but suggest upper UTI)

· Cloudy urine with an unpleasant odour

Fevers, chills, vomiting and malaise (may be noted in patients with cystitis, but more frequently associated with upper UTI)

Diagnosis

Diagnostic studies for UTI consist of dipstick, urinalysis, and culture. No imaging studies are indicated in the routine evaluation of cystitis. Current emphasis in the diagnosis of UTI rests with the detection of pyuria.

Investigation of patients with urinary tract infection

a. Urine R/M/E

b. Dipstick estimation of nitrite, leucocyte esterase and glucose (in uncomplicated UTI)

c. Urine culture & sensitivity (C/S)

Pyelonephritis

d. Renal tract ultrasound or CT

e. Pelvic examination in women

Continuing haematuria or other suspicion of bladder lesion

f. Cystoscopy

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Management of UTI

Choices of Antibiotic are summarized below-

Modified according to urine culture and sensitivity result and/or the clinical response.

The first-choice agents for treatment of uncomplicated acute cystitis include the following:

Nitrofurantoin for 5-7 days
Trimethoprim-sulfamethoxazole (TMP-SMX) for 3 days
Fosfomycin single dose
Beta-lactam antibiotics (eg, amoxicillin-clavulanate, cefdinir, cefaclor, cefpodoxime-proxetil) used when other recommended agents cannot be used

For resistant organisms the alternative drugs:

Amoxicillin-clavulanate or Ciprofloxacin.

In Pregnant Women: choices are

Amoxicillin-clavulanate

Nitrofurantoin

Ampicillin

Cephalosporins (Cefalexin)

Acute pyelonephritis: Choices are -

Amoxicillin-clavulanate

Cefuroxime

Ciprofloxacin

Gentamicin

Considerations in antibiotic selection

Empiric antibiotic selection is determined in part by local resistance patterns
Fosfomycin and nitrofurantoin should be avoided in patients with possible early pyelonephritis
Clinicians may wish to limit use of TMP-SMX, to reduce the emergence of resistant organisms
Fluoroquinolones are typically reserved for complicated cystitis