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Renal Disorders

Urinary Tract Infection Clinical

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

UTIs are common infections that happen when bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis).

Features

Patient may complain of fever, flank pain, supra pubic pain, burning micturition (dysuria ) blood in urine ( hematuria), urinary frequency, urgency etc.

Investigations

Urine R / E, US abdomen (KUB), urine for C / S (in case recurrent UTI)

Management

  • Encourage oral fluids
  • Ask to take care of personal hygiene
  • Syp - Na Acid citrate (Citralka) 2 TSF dissolved in a glass of water ' OR ' Crane berry sachet PO x TDS
  • Tab – Diclofenac (Voltral) 50mg or Tab- Drotaverine (No - spa) 1tab Po x TDS

Acute Cystitis

Acute cystitis is a sudden inflammation of the urinary bladder. Most of the time, a bacterial infection causes it.

  • Tab - Cotrimaxazole (Synbac) 960mg 1 tab PO x BD for 3 days ' OR '
  • Tab – Nitrofurantoin (Furadantin / Uriston ) 100mg , 1 tab PD x BD for 5 4 days
  • Cap - Fosfomycin trometamol (Focin) 500mg , PO x BD for 3 days or Fosfomycin Ultra sachet 3gm PO x stat then on alternate day ( total of 3 doses )
  • Postmenopausal women with recurrent cystitis can be treated with Estradiol vaginal ( estrogen ) cream 0.5 g daily at night for 2 w eeks and then twice weekly thereafter.

Acute Pyelonephritis

Acute pyelonephritis is a bacterial infection causing inflammation of the kidneys and is one of the most common diseases of the kidney.

For hospitalized patients

  • Inj - Ampicillin (Amplus) 1gm IV x QID (ATD) plus
  • Inj - Gentamicin 1mg / kg IV x TDS ' OR '
  • Inj - Ceftriaxone (Oxidil / Rocephin) 1gm IV x OD for 10-14 days
  • Inf - Ciprofloxacin (Novidat) 400mg IV x BD

Non - hospitalized patients

  • Inj – Ceftriaxone (Oxidil / Rocephin) 1gm IV x stat ' OR '
  • Inf - Ciprofloxacin (Novidat) 400mg IV x stat followed by
  • Tab Ciprofloxacin (Ciproxin / Novidat) 500mg 1 tab PO x BD for 7 days ' OR '
  • Tab - levofloxacin (Leflox) 750, 1 tab PO x OD for 7 days ' OR '
  • Tab – Cotrimoxazole (Synbac) 960mg 1 tab PO x BD for 10-14 days

Acute bacterial prostatitis

  • Inj- Ampicillin (Amplus) 1gm IV x QJD (ATD) plus
  • Inj- Gentamicin 1mg / kg IV x TDS until the patient become afebrile4 followed by
  • Tab - Cotrimoxazole (Synbac) 960mg 1 tab PO x BD ' OR '
  • Tab- Ciprofloxacin (Ciproxin / Novidat) 500mg 1 tab PO x BD for 3 weeks.

Chronic bacterial prostatitis: Acute epididymitis

  • Tab - Ciprofloxacin (Ciproxin / Novidat) 500mg 1 tab PO x BD ' OR '
  • Tab – levofloxacin (Leflox) 750, 1 tab PO x OD for 1-3 months

Sexually transmitted

  • Inj - Ceftriaxone (Oxidil / Rocephin) 250mg IM x stat followed by
  • Cap - Doxycycline (Vibramycin) 100mg, 1 cap PO x BD ' OR '
  • Tab- levofloxacin (Leflox) 500mg, 1 cap PO X OD

Non - sexually transmitted

Tab levofloxacin (Leflox) 500mg, 1 cap PO x OD

For Pregnant women

Inj- Cefuroxime (Zinacef) 750mg or Amoxicillin + clavulanic acid (Augmentin / Amoxiclav / Calamox )1gm IV x BD for 3 days, followed by tab- Cefuroxime (Zinacef)125mg or Tab Amoxicillin + clavulanic acid (Augmentin / Amoxiclave / Calamox)625mg PO x BD for 10 days.

In case of recurrent UTI during pregnancy

Use prophylactic antibiotics Tab- Amoxicillin (Amoxil) 500 PO x OD throughout pregnancy or after each intercourse.Note: In diabetics, elderly and women using diaphragm pre - treatment culture should be sent and treatment should be given for a week at least.