دكتر فهيمه هداوند

Uncomplicated urinary tract infection Hadavand fahimeh Infectious disease specialist

Classification:  1) uncomplicated: cystitis and pyelonephritis in women without abnormal metabolic, anatomic disease

2) Classification:  cystitis and pyelonephritis in men children and women with anatomical and metabolic disease such as diabetes, neurologic bladder

Microbiology:  E.coli 75-95% of episodes  Others: klebsiella pneumonia and gram postive such as staphylococcus suprophyticus, enterococcus faecalis, streptococcus agalactiae

Uncomplicated:  Patient: healthy, ambulatory women with no history of anatomical or functional abnormality of the urinary tract.

Clinical:  Cystitis: dysuria, with or without frequency, urgency, suprapublic pain or hematuria

Pyelonephritis:  fever, chills, flank pain, CVAT, nausea, vomiting, with or without symptoms of cystitis.

 Dysuria is common with urethritis or vaginitis. But cystitis is more likely when symptons include frequency, argency, or hematuria.  When the onst is sudden or severe.

Diagnosis: on the basis of typical symptoms.  U/A and U/C is not indicated in cystitis but recommended for pyelonephritis

 Assesment of pyuria and bacteruria with dipstick  Pyuria: dipstick for leukocyte esterase.  Bacteruria: dipstick for nitrites.  Sensivity: 75% specifity: 82%

 Urine culture:10 5 CFU per milliliter

 Antimicrobial regimen  First line therapy: - nitrofurantion 5 days - Tmp-smx3 days - Fofomycia3g/S.D - pivmecillinam400 mg BD (3-7 days)

Side effects:  Nitrofuranstion: nausea, headache  Tmp-smx: urticaria, vomiting, photosensivity  Fosfomycin: diarrhea headache, vaginitis  Pivmecillinam: nausea, headache, diarrhea.

Second line therapy side effect  Fluoroquinolones: 3days insomnia, headache drowsiness  Betalactams (3-7 days)uriticaria  (e.g. co-amoxi, cefaclor)rash, vomiting

 Acute uncomplicated pyelonephritis:  Fluroquinolones 5days  Tmp-smx 14days  Beta lactams days

 Recurrent cystitis  Relaps: time (one or two week after cystitis)  Treatment: board spcctrum AB. Such as fluoroquinolone.  Reinfection: at least 1 month after cystitis  Treatment: first line short course regimen

 Antimicrobial prophylaxis  Three or more urinary tract infection in the past 12 months.  Or two or more in the past 6 months.

Follow up  Cystitis and pyelonephritis is not recommended but persistant hematuria or multiple early recurrences.  in pyelonephritis when fever 48 to 72 h after treatment or severe or worsening illness

Prevention of recurrent acute uncomplicated cystitis  1) nonantimicrobial  2) antimicrobial

Nonantimicrobial Behavioral: No spermicide, urination before intercourse Biologic: Cranberry juice, topical estrogen. Adhesion blocker (D-mannose)

Antimicrobial  Self diagnosis and self treatment: u.c be obtained periodically for confirme and susceptibilities  Antimicrobial prophylaxis.  Postcoital: single dose  Continuous: daily bed time dose: for six month

Antimicrobial:  Nitrofurantion: mg  Tmp-smx: 40mg and 200 mg  Tmp: 100 mg  Cephalexin: