Makindo Medical Notes

For simple UTIs in women, treat with 3 days of antibiotics. ➡️ Use 7 days for men, pregnant women, or catheterised patients (and change the catheter). ⚠️ Do NOT treat asymptomatic bacteriuria except in pregnancy or before urological procedures.

ℹ️ About

• 👩 ~30% of women experience a UTI in their lifetime.
• 👨 UTIs are uncommon in men and usually prompt further investigation.
• 🚨 Infection can ascend → pyelonephritis (flank pain, fever).
• 📡 Ultrasound: indicated in suspected upper UTI or obstruction.

📖 Definitions

• Bacteriuria: Bacteria in urine.
• Pyuria: Pus cells in urine.
• Asymptomatic Bacteriuria: >10⁵ CFU/ml, no symptoms, normal bloods.
• UTI: Bacteriuria + symptoms ± abnormal bloods.

🧾 Clinical Terms

• Frequency: Voiding >7/day (2-hourly), often with bladder inflammation.
• Urgency: Sudden need to void, often small volumes.
• Dysuria: Painful urination from urethral/bladder inflammation.

🧪 Urinalysis

• 🟢 Nitrites: Suggest Gram-negative bacteria (specific).
• ⚪ Leukocyte esterase: Indicates pyuria (sensitive, less specific).
• Both positive → send MSU for culture.

🧬 Aetiology

• Ascending infection from perineum.
• Risk factors: 💏 sexual activity, 💎 renal stones, ♿ poor bladder emptying, 🧴 catheters, 🤰 pregnancy, 💉 diabetes, 🛡️ immunosuppression.
• 👶 Children: vesicoureteric reflux → scarring risk → detect early (<5 years).

🦠 Typical Organisms

• E. coli (~70%).
• Proteus mirabilis: stone-associated.
• Klebsiella, Enterococcus faecalis.
• Staph. saprophyticus: young, sexually active women.
• Mycobacterium tuberculosis: sterile pyuria (rare).

👩‍⚕️ Clinical Presentation

• Foul-smelling urine, dysuria, frequency, urgency.
• Suprapubic pain, malaise, retention, ± haematuria.
• Systemic illness = suspect pyelonephritis.

🔎 Investigations

• Dipstick: Protein, leukocyte esterase, nitrites.
• Microscopy & Culture: gold standard.

💊 Management

• 🏠 Outpatient unless systemic/pyelonephritis features.
• 💧 Hydration (3+ L/day).
• Empirical antibiotics → refine after culture.
• Catheterised? Replace catheter.
• Recurrent infection → consider prophylaxis (6–12 months low-dose antibiotics).

💉 Antibiotic Choices

• Nitrofurantoin: 100 mg MR BD (avoid if eGFR <45).
• Trimethoprim: 200 mg BD (if resistance low).
• Pivmecillinam: 400 mg stat → 200 mg TDS.
• Fosfomycin: 3 g single dose.
• Amoxicillin: only if culture-proven susceptibility.

👩 Non-Pregnant Women (16+)

• First-line: Nitrofurantoin, Trimethoprim, Pivmecillinam (3 days) OR Fosfomycin (single dose).

🤰 Pregnant Women

• 7 days: Nitrofurantoin, Amoxicillin, or Cefalexin (per sensitivities).
• ⚠️ Always send urine culture.

👨 Men (16+)

• Trimethoprim or Nitrofurantoin (7 days). Avoid Nitrofurantoin if prostatitis suspected.

🛡️ Prevention

• Hydrate ≥2 L/day, void every 2–3 h.
• Void before bed & after intercourse.
• Avoid perfumed bath products.
• Prevent constipation → better bladder emptying.

📚 References

• NICE Guideline – UTI Treatment

💡 Exam Pearl: • Asymptomatic bacteriuria → treat only in pregnancy. • Men with UTI → always investigate (rare, often structural cause). • Dipstick alone is unreliable in >65s.