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URINARY TRACT INFECTION

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URINARY TRACT INFECTION Powered By Docstoc
					Ray Chester N. Fabian FM Rotation: Aug 25- Sept 9, 2008

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Gowth of >100 cfu/ml of MSU in nonpregnant women (18-50 y/o) Pyuria of > 5-8/hpf Symptoms:
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Dysuria Frequency Urgency Hematuria Hypogastric pain

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Pre-treatment lab exam: Urinalysis Urine C/S: not recommended Duration of treatment: 3 days
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Cotrimoxazole 800/160 mg BID Norfloxacin 200mg BID Ciprofloxacin 250mg BID Ofloxacin 200mg BID Co-amoxiclav 375mg TID Pefloxacin 400mg BID Nitrofurantoin 100mg QID

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Post-treatment follow-up:
 If symptoms not resolved in 3 days, extent up to 7

days  If not resolved in 7 days, treat as complicated UTI

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Symptoms:
 Fever >38 C  Chills

 Flank pains
 CVA tenderness  Nausea  Vomiting  No structural or functional abnormalities

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Labs
 Pyuria of >5/hpf  Bacteuria >10,000/hpw in culture

 Gram stain- to differentiate gram (+) and gram (-)
 Urine C/S- more precise and cost-effective use of

antibiotics  Blood C/S-hospitalized PX

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Indications for admission:
 Inability to maintain oral hydration and meds  Concern about compliance

 Uncertain diagnosis
 Severe illness  Severe pain  Signs of sepsis

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Treatment: (mild to moderate illness)
 Oral flouroquinolones 400mg BID x 3days  TMP/SMZ 800/160mg BID x 3 days

 Co-amoxiclav 625mg TID x 3 days

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Treatment: (mild to moderate illness)
 IV aminoglycosides  IV flouroquinolones

 3rd gen cephalosporins
 Then shift to oral if afebrile x 24h  To complete for 14 days

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Definition: >100,000 cfu on 2 consecutive msu/ one catheterized specimen No symptoms Risk group:
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Elderly DM Long term indwelling cath GUT abnormality Renal transplant patient

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Antibiotic regimen/ oral regimen
 Ciprofloxacin 250 BID x 14d  Norfloxacin 400mg BID x 14d

 Ofloxacin 200mg BID x 14d
 Cotrimoxazole 800/160 mg BID x 14d

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Antibiotic regimen/ parenteral regimen
 Ampi/ genta  Ceftazidime

 Ceftriaxone
 Ciprofloxacin  Imepenem

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Episodes of acute uncomplicated uti by urine culture occuring 2x a year Treatment of individual episodes 7 day treatment with Co-amoxiclav, ciprofloxacin, mofloxacin 3 day treatment for simple uncomplicated cystitis

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Indications for prophylaxis
 If frequency of UTI not acceptable and interferes

with normal activities  Withhold if freq is tolerable to px  STRATEGIES (2 METHODS)
▪ CONTINUOS- DAILY LOW DOSE (6MOS) ▪ POST-COITAL-SINGLE DOSE AFTER SEXUAL CONTACT

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INDICATIONS FOR SCREENING OF UROLOGIC ABNORMALITIES:
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Gross hematuria Obstructive symptoms Persistent infections (+) urea-splitting organism History of pyelonephritis Urolithiasis Childhood UTI Elevated serum creatinine

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Screening tools
 Renal UTZ  Plain abdominal X-ray

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Bacteuria with functional or urological abnormalities in the urinary tract or kidneys Risk factors:
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Indwelling catheter Incomplete emptying of the bladder Obstructive uropathy Vesicoureteral reflux Azotemia secondary to renal disease Renal transplantation Immunocompromised DM/CA Antibiotic resistance Males

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Labs:
 Pretreament urine GS/CS (rpt 1-2 weeks after

completion)  Antimicrobial regimen

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Oral regimen:
 Ciprofloxacin  Norfloxacin

 Cotrimoxazole

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Parenteral regimen:
 Ampi/ genta  Ceftazidime

 Ceftriaxone
 Ciprofloxacin  Imepenem


				
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