Urinary Tract Infections - Quick Reference

This is a Quick Reference article. See also the main article Urinary tract infections Urinary Tract Infections.

Essentials

Treatment according to the level of the infection, see table T1.
- Cystitis symptoms include urinary frequency and burning on urination.
- Pyelonephritis is suggested by fever, back or flank pain, as well as CRP> 40 mg/l.
An occasional cystitis in a basically healthy woman can be treated with antimicrobials without performing urinalysis (picture Urinalysis in the Diagnostics of Urinary Tract Infections).
In other patients with suspected urinary tract infection (UTI), bacterial culture of the urine should be performed even if the result is not yet available at the onset of treatment.
In men and children, further investigations are ordered after the very first UTI.
- UTI in a child: see Urinary Tract Infection in a Child
- Prostatic hyperplasia predisposes the patient to infections. Palpate the prostate and, if indicated, determine plasma PSA and creatinine. After a febrile infection, a urologist should be readily consulted.
In pregnant women and children, the cure is verified by a control culture obtained 3-7 days after the termination of the medication. If the patient is still symptomatic, the control specimen should be obtained immediately after the end of the antimicrobial course.
The prevalence of asymptomatic bacteriuria increases with advancing age. Screening and treatment is warranted in pregnant women only.
Differential diagnosis: sexually transmitted diseases (chlamydia and gonorrhoea), urethral syndrome, overactive bladder, infection caused by obstruction to urinary flow

	Lääke	Annos
Cystitis in a female patient	Trimethoprim	160 mg × 2 or 300 mg × 1 for 3 days
	Nitrofurantoin	75 mg × 2 for 3 days
	Pivmecillinam	200 mg × 3 or 400 mg × 2 for 3 days
Pyelonephritis During pregnancy the treatment is always initiated at a hospital.	Fluoroquinolones	Levofloxacin 250-500 mg × 1, ofloxacin 200 mg × 2, ciprofloxacin 500 mg × 2 p.o., duration of treatment 7 days
	Cefuroxime	750-1 500 mg × 3 for 10 days intravenously
	Sulpha-trimethoprim	160/800 mg × 2 for 10 days
UTI in a male patient Further urological investigations always indicated	Trimethoprim	In an afebrile infection only, dose as above, duration of treatment 7 days
	Fluoroquinolones	Dose as above, duration of treatment 7 days; in a febrile infection or in connection with an acute bacterial prostatitis, the duration of treatment is 14 days
Cystitis and asymptomatic bacteriuria during pregnancy	Nitrofurantoin	Dose as above (cephalexin 500 mg × 3), but the duration of treatment is 5 days
	Pivmecillinam
	Cephalexin
Low-dose prophylactic medication 6-12 months To be considered if there are at least 3 infections per year	Primary: trimethoprim, nitrofurantoin	Trimethoprim 100 mg, nitrofurantoin 50-75 mg in the evening
	Secondary: methenamine hippurate, norfloxacin, some other fluoroquinolone	Methenamine hippurate 1 g × 2, norfloxacin 200 mg × 1 or or at 3 nights per week