1 / 15

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

autumn-levine
Télécharger la présentation

Management of UTIs

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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?

More Related