Urinary Tract Infections (UTIs)

Cooper, K. L., G. M. Badalato, and M. P. Rutman. "Infections of the urinary tract." Campbell-Walsh-Wein Urology. 12th ed. Elsevier (2020): 1129-1201.

Cooper, K. L., G. M. Badalato, and M. P. Rutman. "Infections of the urinary tract." Campbell-Walsh-Wein Urology. 12th ed. Elsevier (2020): 1129-1201.

UTI Evaluation

Presenting symptoms

Collecting the Sample

Lab Findings

Defining Asymptomatic Bacteruria

Oral Antibiotics for Outpatient UTIs

Antibiotic Normal Dosing Side Effects Tips
Nitrofurantoin (Macrobid) 100mg BID GI effects
Peripheral neuropathy
Hemolysis if G6PD
Pulmonary hypersensitivity reaction (rare)
Only works well for GU infections (not tissue)
Don't give if GFR < 50 (inadequte excretion)
Caution in elderly patients
Do not take with quinolones, Mg, or probenecid
Trimethoprim-Sulfamethoxazole (Bactrim) Double-Strength (800/160mg) BID Rashes
GI effects
Hyperkalemia
Stevens Johnson syndrome (rare)
Avoid in pregnancy
Can exacerbate effects of warfarin
Fosfomycin 3g sachet x1 Headache
GI effects
Vaginitis
Not used frequently in US due to cost ($70-90)
Ciprofloxacin (Cipro)
Levofloxacin (Levaquin)
500mg BID
250mg BID or 750mg daily
GI effects, dizziness, photosensitivity
CNS effects
Tendon rupture
Avoid in children or pregnancy
Decreased oral absorption with iron, zinc, or antacid (separate by 2hrs)
Can lower seizure threshold
Cefuroxime
Cefoxitin
Do not use if patient has prior immediate hypersensitivity to penicillins
Use with caution if delayed hypersensitivity to penicillins
Ampicillin (w/ Sulbactam) 875/125mg BID Hypersensitivity rash
Diarrhea
Rash more likely when viral disease present

Cystitis

Tips for diagnosis/management

Factors indicating complicated cystitis

Emphysematous cystitis

Renal Infections

Acute Pyelonephritis

Cooper, K. L., G. M. Badalato, and M. P. Rutman. "Infections of the urinary tract." Campbell-Walsh-Wein Urology. 12th ed. Elsevier (2020): 1129-1201.

Emphysematous Pyelonephritis

Acute Focal/Multifocal Bacterial Nephritis

Renal Abscess

Infected Hydronephrosis +/- Pyonephrosis

Perinephric abscess

Chronic pyelonephritis

Xanthogranulomatous pyelonephritis (XGP kidney)

Genital infections

Fournier gangrene

Periurethral abscess

Cooper, K. L., G. M. Badalato, and M. P. Rutman. "Infections of the urinary tract." Campbell-Walsh-Wein Urology. 12th ed. Elsevier (2020): 1129-1201.

Special considerations

Spinal Cord Injury Patients

References