Urinary Tract Infection and Pyelonephritis

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Description

This is an infection, often bacterial, of the ureters, bladder and urethra commonly caused by gram-negative bacteria, including E. coli, Klebsiella species, and Proteus species. It can also affect the kidneys and renal pelvis, often bilateral in pyelonephritis. Urinary tract infection occurs much more frequently in women than in men, especially in pregnancy.

Signs and Symptoms

  • Frequency
  • Urgency
  • Dysuria (pain on passing urine)
  • Fever
  • Nausea and Vomiting
  • Lower abdominal pain
  • Flank pain

Investigations

  • Urinalysis
  • Urine microscopy, culture and sensitivity

Treatment

  • Nitrofurantoin 50 - 100mg 6-12 hourly for 5 to 7 days

        OR

  • Nalidixic Acid 250-500mg 6 hourly for 5 days
  • For complicated UTIs (UTI in immunocompromised patients, in males, in pregnancy, associated with stones, catheters, or involving the kidneys), use Intravenous Antibiotics:
  • Ceftriaxone 2g once daily

        OR

  • Ciprofloxacin 400mg twice daily

NB: Culture should guide the choice of antibiotics. After 24 to 48 hours without fever, most patients receiving I.V therapy can be switched to oral regimes.