UTI/Cystitis/Dysuria

Definitions

  • Dysuria: painful urination (i.e. burning)
  • Frequency: urinating often
  • Urgency: sudden inevitable urge to urinate (involuntary spasm of muscle wall)
  • Incomplete emptying
  • Hesitancy: involuntary delay/inability in starting urination

Urinary Tract Infection

  • History and physical
    • Patient may complain of dyruria, frequency, urgency, incontinence, malodorous urine, N/V (pediatrics and elderly), fever
  • Urinalysis: look for leukocytes, nitrites
  • Common pathogens: Escherichia coli, enterococci, Pseudomonas aeruginosa, candidal species, and Klebsiella pneumoniae
  • Treatment
    • Antibiotics:
      • TMP-SMX (Bactrim, Septra)
        • TMP-SMX DS  bid x 3 d
        • 160 mg TMP/800 mg SMZ PO q12h x 10-14 d
        • Covers common urinary tract pathogens (aerobic gram-positive and gram-negative bacteria).  Does not cover P aeruginosa.
      • Nitrofurantoin (Macrobid) 100mg bid x 7 d
        • Effective against S saprophyticus, E faecalis, and E coli.  Does not cover Proteus, Serratia, or Pseudomonas species.
      • Ciprofloxacin 250 mg bid x 3 d
        • Covers P aeruginosa.
    • Bladder anaesthesia: phenazopyridine (Pyridium) 200 mg tid  [note: turns urine orange]



 

Pediatric UTI

  • VCUG and ultrasound
    • All boys
    • Girls < 36 months
    • Girls 3 – 7 years with fever >38.5
  • DMSA

Leave a Comment