1. Shamaila Masood 19/08/09

2. Sceanario 1 – Pt A A 25 y old woman presents with 2/7 history of urgency. This is the first time she has had these symptoms She uses a condom. Dipstick shows protein and leucocytes

3. True or False? UTI is the most likely diagnosis and MSU is unnecessary Empirical therapy with amoxicillin is appropriate A 3 day course of abx is sufficient The patient should be encouraged to drink water and tea If the symptoms fail to resolve the most likely explanation is the infection involves the upper urinary tract

4. True or False In recurrent cystitis a MSU should be obtained Recurrent cystitis should always be treated with 7-10 days abx Recurrent UTIs may be associated with sexual activity

5. Sceanario 1 – Pt A cont… An MSU grow E.Coli resistant to trimethoprim. Pt A completed her course of trimethoprim and now says she is symptom free and well. Is a further course of the appropriate antibiotic necessary?

6. Which one of the following cause UTIs commonly ? E.coli Strep pneumoniae Staph saprophyticus Group A strep Enterococcus

7. In a woman presenting for the first time with symptoms of cystitis which is correct A urine dipstick is mandatory The presence of nitrites is suggestive of UTI The symptoms could be cause by a STI A 5-7 day course of trimethoprim is needed Drinking caffeine improves symptoms

8. Recurent UTIs may be associated with Sexual intercourse Use of spermicide-coated condoms Atrophic vaginitis Diabetes No identifiable cause in majority of cases

9. Which abx are first line treatment Amoxicillin Augmentin Trimethoprim Ciprofloxacin nitrofurantoin

10. Management 50 % E.Coli resistant to amoxicillin First Line Trimethoprim Nitrofurantoin Second Line Augmentin Cephalosporins Fluoroquinolones

11. Causes of Recurrent Cystitis Post coital Diabetes Obesity Chronic constipation Reduced fluid intake Reduced voiding Atrophic vaginitis Tampons!

12. When to send an MSU Complicated UTI Dipstick neg but symptoms suggestive Relapse/recurrent infection Pregnancy Symptoms in the elderly Failure to respond Suspected pyelonephritis

13. Sceanario 2 – Pt B A 26 y old woman presents for review at 10 weeks gestation. She has no urine symptoms.

14. True or False? She should be screened for asymptomatic bacteraemia with a dipstick If asymptomatic bacteraemia is detected the risk of acute pyelonephritis during pregnancy is 10-30% Asymptomatic bacteraemia during pregnancy should always be treated with antibiotics Nitrofurantoin can be safely administered during the first trimester

15. Reference eModule on doctors.org.uk