Beruflich Dokumente
Kultur Dokumente
Recurrent UTI: patients with at least two infections within 6 months or three or
more during a single year, in which the initial episode is resolved and
is followed by another infection.
Classification
Upper UTI = Pyelonephritis
Lower UTI = Cystitis
Complicated UTI
Uncomplicated UTI
Further invstigation
Adult female
(lower UTI)
Male
(Any UTI)
Treat without
further
investigation
Ultrasound
? Cystoscopy
Check renal
cunction
Children
(Any UTI)
Upper UTI
or
Complicated UTI
Ultrasound
? MCU
Blood cultures
Ultrasound
? IVP
Check renal function
2. Urinalysis
The presence of 10 WBC / mm3 fresh un-spun midstream urine
The presence of 10 WBC / high-power field sediment midstream
urine
3. Culture
4. Radiological evaluation
Ultrosound
Plain abdominal radiography
Intravenous urography
CT scanning
Lower UTI
Upper UTI
Dysuria
Frequency
Suprapubic pain
Malodorous urine
Haematuria
Normal temperature
Systemically unwell
Fever rigors
Loin pain and tenderness
Nausea and vomiting
Hypotension and shock
Features of lower urinary
tract infection
Midstream urine
Significant bacterial
count (cells/ml)
> 100.000
Slide-hole catheter
>30.000
1000
Suprapubic aspiration
Type of collection
Cured
(sterile urine)
No investigation
Failure or relapse
(identical pathogens)
Reinfection
(new pathogen)
Severe illness
Moderate severity
No resolution
in 5 days
Resolution
in 5 days
Urologic evaluation
No resolution
in 5 days
Radiologic evaluation
Treatment 14 days
Yes
5 Days
Switch to or continue
oral regimen
For total 2 weeks
No
Conventional antibiotic
therapy 2-6 weeks
Sexually active
Antibiotic therapy :
On demand or
Postcoital or
Longterm prophylaxis
Diagnosis
Reinfection
3 year
2 year
Postmenopausal
Conventional antibiotic
therapy 3-7 days
Estrogen substitution
(oral & topical)
Antibiotic therapy :
On demand or
Longterm prophylaxis
Madersbacher S, et al. Curr Opin Urol 2000 ; 10
Dose*
Nitrofurantoin
50 mg
Trimethoprim
100 mg
Co-trimoxazole
0.24 g
Norfloxacin
200 mg
Ciprofloxacin
125 mg
Cephalexin
125 mg
( useful if renal insufficiency)
Hexamine hippurate
1g
* Treatment is effective if taken each night, alternate nights, three times a week,
or just after intercourse
5. Asymptomatic bacteriuria
Possible
Not indicated
Pregnancy
Diabetes mellitus
Elderly
Before an invasive
genitourinary
procedure
Short-term
indwelling
catheterization
Intermittent
catheterization
Long-term
indwelling catheter
Renal transplant
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