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.
- 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 hyperplasiapredisposes 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
Choice of drug to treat an acute UTI in an adult in primary care
| 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 |