• Skip to main content
  • Skip to primary sidebar
  • Skip to footer
  • Home
  • About
  • Consumer Info
  • Guideline Notes
  • Medicine and Media
  • Pharmacogenomics
  • Visit My Etsy Store

Digital PharmD

Informatics in Pharmacy

Urinary Tract Infections

August 13, 2018 By Dr. G, PharmD

Print Friendly, PDF & Email

When presented with a urinary tract infection, you have to ask:

  1. Cystitis or pyelonephritis?
    • Lower UTI – cystitis: dysuria, frequent urination, urgency, hematuria
    • Upper UTI – pyelonephritis: frequency, dysuria, hematuria, suprapubic pain, flank pain, tenderness, elevated WBC, nausea/vomiting, casts in urine
  2. Complicated or Uncomplicated
    • Complicated: males, hospital-acquired, pregnancy, anatomic abnormality of the urinary tract, history of childhood UTI, recent antimicrobial use, indwelling catheter, immunosuppression, recent urinary tract instrumentation
    • Recurrent cystitis: infection within 14 days of the previous antibiotic discontinuation

Treatment:

  • Uncomplicated cystitis:
    • Bactrim BID for 3 days
    • nitrofurantoin 100 mg BID * 5 days
    • fosfomycin 3 g for 1 dose
    • fluoroquinolone for 3 days if persistent.  Avoid if other options.
    • beta-lactam for 7 days
  • Uncomplicated pyelonephritis:
    • outpatient:
      • Bactrim for 14 days
      • fluoroquinolone for 5-7 days (2nd line)
      • beta-lactam for 10-14 days (3rd line)
    • When uropathogen resistance is greater than 10%, use an initial dose of ceftriaxone or an aminoglycoside
  • Complicated UTI:
    • all are in inpatient:
      • fluoroquinolone for 5 days
      • aminoglycoside for 14 days
      • extended spectrum beta-lactam for 14 days (usually ceftriaxone)
    • pregnancy
      • 7-day treatment
      • amoxicillin
      • nitrofurantoin (avoid if other options)
      • cephalexin
      • avoid FQs, tetracyclines, aminoglycosides, Bactrim in last trimester
    • recurrent cystitis
      • longer treatment (2-6 weeks)
      • If patient has 2 or fewer recurrent infections, use patient initiated therapy
      • If patient has 3 or more and they are related to sex, use intercourse prophylaxis with Bactrim, cephalexin or nitrofurantoin
      • If 3 or more not related to sex, daily or 3 times a week prophylaxis with
      • Bactrim, cephalexin or nitrofurantoin
    • Catheter-related UTI
      • About 5% of patients with catheter will develop a UTI per day (by day 30, up to 95% will have UTI).
      • Only treat symptomatic patients. 
      • Usually caused by E.coli, candida, enterococcus, Pseudomonas, K. pneumonia, enterbacter
      • Treat for 7 days if symptoms resolve promptly, 14 days if not
    • Prostatitis and epididymitis
      • Usually gram 1 organisms
      • Treat for 4 weeks
      • For chronic bacterial prostatitis, give therapy for 1-4 months with Bactrim or a fluoroquinolone
      • Epididymitis
        • If older than 35, probably caused by enteric organisms. Treat for 10 days to 4 weeks.
        • If younger than 35, probably gonococcal or chlamydial.  Treat with ceftriaxone 250 mg times one and doxycycline BID for 10 days.

Filed Under: Infectious Disease

Primary Sidebar

Newsletter

More to See

What You Need to Know About the 2022 Avian Influenza Outbreak

March 20, 2022 By Dr. G, PharmD

Endocarditis Guideline Review

February 24, 2022 By Dr. G, PharmD

Sinus Troubles: When Should I See My Doctor

January 5, 2022 By Dr. G, PharmD

Tags

acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020

Footer

Medical Disclaimer

The medical information on this website is provided “as is” without any representations or warranties, express or implied. GoPharmD makes no representations or warranties in relation to the medical information on this website.

GoPharmD does not warrant that:

  • the medical information on this website will be constantly available, or available at all; or
  • the medical information on this website is complete, true, accurate, up-to-date, or non-misleading.
  • You must not rely on the information on this website as an alternative to medical advice from your doctor or other professional healthcare provider.
  • If you have any specific questions about any medical matter you should consult your doctor or other professional healthcare provider.

Recent

  • Smoking
  • What You Need to Know About the 2022 Avian Influenza Outbreak
  • Endocarditis Guideline Review
  • Sinus Troubles: When Should I See My Doctor
  • Common Pharmacogenomic SNPs and Interactions

Search

Tags

acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius Guidelines heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020