UTI refers to inflammation of the urinary tract, which includes the renal parenchyma (pyelonephritis), the bladder (cystitis), the prostate in males (prostatitis) and the urethra (urethritis). The range of possible symptoms caused by UTI is extremely broad, from no symptoms to symptoms referable the lower urinary tract (e.g. dysuria and frequency), to symptoms indicative of an upper UTI (e.g. loin pain and costo-vertebral angle tenderness), to full-blown septic shock. The vast majority of acute symptomatic infections occur in young women. Acute symptomatic urinary infections are unusual in men under 50. It is also important to note that asymptomatic bacteriuria is very common in elderly men and women. Escherichia coli causes approximately 80 % of acute infections in patients without catheters, stone or other urologic abnormalities. On the other hand, organisms like klebsiella, enterobacteria, proteus, serratia and psuedomonas assume greater importance in recurrent infections and infections associated with urologic manipulations as in catheter associated nosocomial infections.
Diagnosis: Clinical
Urine analysis and Gram stain showing pyuria and bacteriuria
Urine culture. Bacterial colony count of 105 organisms per milliliter or greater in urine generally indicates urinary tract infection.
Treatment
A) Acute, Uncomplicated UTI in women:
First line:
Sulfamethoxazole+trimethoprim, 800mg/160 mg p.o. bid, for 3-5 days.
(For S/E, C/I and Dosage forms, see page 4)
Alternative
Amoxicillin, 250-500mg, tid, p.o. for 3-5 days. For children: 20-40 mg/kg/day in 4 divided doses. (For S/E, C/I and Dosage forms see page 6)
B). Acute, Uncomplicated Upper UTI (Pyelonphritis) in women:
The same antibiotics used for Lower UTI could be used, but the period of treatment should extend for 7-10 days.
N.B.
1. In severe cases, antibiotics should be given parentrally for the first 48-72 hours.
2. In severe cases addition of aminoglycosides like Gentamycin could be considered
C.) UTI in Men:
First line:
Sulfamethoxazole+trimethoprim, 800 mg/160 mg p.o. bid, for 10-14 days.
(For S/E, C/I and Dosage forms, see page 4)
Alternative
Amoxicillin, 250-500 mg tid, p.o. for 10-14 days. For children: 20-40mg/kg/day in 4 divided doses. (For S/E, C/I and Dosage forms: see page 6)
D. For recurrent and resistant cases of UTI:
An intensive urologic evaluation is mandatory and antibiotic choice should be guided by drug sensitivity test from urine culture.
