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Urinary Tract Infection- Adults

Urinary Tract Infections is one of the commonest presentation seen in the primary care. This review of UTI in adults on A4Medicine provides the clinician with a practical approach to UTI. The latest guidance from Public Health England – a quick reference guide for primary care has been shown as an easy to use to use visual. Not exhaustive but this review covers the useful aspects – when to request culture or what we usually call MSU and use of the first line antibiotics Trimethoprim Avoid in blood dyscrasias Potential anti-folate effect Predominantly excreted by kidneys – caution in renal impairment Can be used during pregnancy ( not first line )
○ if used in 1st trimester- check if woman is taking folic acid
○ prescribe folic acid 5 mg/ day Breastfeeding- can be used Generally well tolerated , severe SEs are rare ( refer BNF )

Nitrofurantoin Avoid in renal impairment – check BNF for dosage Acute porphyria Glucose-6-phosphate dehydrogenase deficiency Prescribe with caution in Peripheral neuropathy – may ↑ occurence Can be used in pregnancy , breast feeding ( avoid at term risk neonatal hemolysis ) – refer to BNF for details

Bacteriuria-bacteria present in urine- shown by culture or microscopy

Asymptomatic bacteriuria-Bacteriuria without any typical symptoms of lower or upper UTI

UTI-significant bacteriuria and characteristic symptoms and signs of UTI ie dysuria , frequency , suprapubic tenderness , urgency ,polyuria , haematuria

Lower UTI-Infection of bladder Cystitis – used synonym for lower UTI
( technically inflammation of bladder and can be non- infectious )

Upper UTI-Includes pyelitis – infection of proximal part of ureters and
Pyelonephritis – infection of kidneys and the proximal part of ureters

Recurrent UTI-Repeated UTI due to 
Relapse ( same strain within a short period eg 2 weeks ) or 
Reinfection ( different strain or species more than 2 weeks after treatment )

Uncomplicated UTI-UTI by usual pathogen with a normal urinary tract and normal kidney function

Complicated UTI-UTIs associated with metabolic disorders that are 2ary to anatomic or functional abnormalities that impair urinary tract drainage or that involve atypical pathogens eg yeast

Risk factors- Sexual behaviour and contraceptive devices Hormonal deficiency in post menopause Secretory type of certain blood groups Controlled diabetes mellitus Pregnancy Male gender Badly controlled diabetes Relevant immunosuppression Connective tissue diseases Prematurity , new-born Relevant renal insufficiency Polycystic nephropathy Urethral obstruction
stone , stricture Transient short term catheterization Asymptomatic bacteriuria Controlled neurogenic bladder dysfunction Urological surgery Long term urinary catheter treatment Non resolvable urinary obstruction Badly controlled neurogenic bladder

Differential diagnosis- Overactive bladder Herpes genitalis ( HSV ) N.Gonorrhoeae Chlamydia Cancer of bladder and upper urinary tract Vaginitis Prostatitis Nephrolithiasis Trauma Urinary tract tuberculosis Urinary tract neoplasm Intra-abdominal abscess Sepsis- other than GU system Foreign body in bladder Asymptomatic bacteriuria

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