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Management of UTIs

Management of UTIs. Chris Longstaff. Adult Non-Pregnant Women. When not to dipstick?. Do not dipstick if UTI highly likely SIGN and HCA - more than 2 symptoms CKS – moderate-severe symptoms 90% of these do have a UTI. When to Dipstick?. Dipstick if diagnosis uncertain

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Management of UTIs

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  1. Management of UTIs Chris Longstaff

  2. Adult Non-Pregnant Women

  3. When not to dipstick? • Do not dipstick if UTI highly likely • SIGN and HCA - more than 2 symptoms • CKS – moderate-severe symptoms • 90% of these do have a UTI

  4. When to Dipstick? • Dipstick if diagnosis uncertain • With only 1 symptom 20% false negative rate • SIGN advise to offer this group Abx even with negative dip • HPA advise only treat this group if nitrite or leukocyte positive dipstick • Looking for cloudiness is also reasonable (91% of non-cloudy urine in this group is not infected)

  5. Urine Culture • Often results only available after symptoms settle • Relatively expensive lab investigation • Do not culture unless treatment failure (SIGN, CKS, EAU all agree) • If all possible UTIs were cultured • Cost per day of symptoms saved - £215 • Reduction in duration – 0.04-0.32 days

  6. Antibiotics • Acute Cystitis tends to be self-limiting in this group • If UTI likely, offer antibiotics with an explanation • Average duration • 4-9 days without antibiotics • 3-8 days with antibiotics

  7. Pregnant Women

  8. Asymptomatic Bacteriuria • 20-40% of pregnant women with asymptomatic bacteriuria develop pyelonephritis in pregnancy • NNT is 7 • Association with • increased low birth weight • low gestational age • increased neonatal mortality

  9. Asymptomatic Bacteriuria Screening • Needs MSU culture • Send at first booking appointment • Confirmed positive needs 2 positive cultures growing the same bacteria • (40% false positive for single positives)

  10. What to do with Positive Results • Treat according to sensitivities • If there are options, CKS advises the following order of preference • Amoxicillin • Nitrofurantoin • Trimethoprim (unless folate defic) • Cefalexin • Recheck • At every subsequent antenatal visit (SIGN and CKS)

  11. Treating Acute Cystitis • Insufficient evidence for short courses, so treat for 7 days • CKS advises empirical treatment with the following Abx in order of preference • Nitrofurantoin • Trimethoprim • Cefalexin • (not Amoxicillin as resistance is too high)

  12. Men

  13. Why do they have a UTI? • Often underlying complications • Consider Chlamydia • Refer if 2 or more episodes in 3/12

  14. Concomitant Prostatitis • A significant proportion of males with UTI also have prostatitis • If inadequately treated this can lead to chronic prostatic infection or abscess • 50% of all men with UTI also have prostatitis • 90% of men with febrile UTI also have prostatitis • Only 9% of these actually had a tender prostate

  15. Treating Prostatitis Treat for 14 days Quinolone 1st line Not Nitrofurantoin Recommended by EAU and SIGN for treatment of all male UTIs Only treating UTI Treat for 7 days Nitrofurantoin or Trimethoprim 1st line Recommended by CKS and HPA To Treat Prostatitis or Not?

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