Urology Book

http://www.fpnotebook.com/

Recurrent CystitisAka: Recurrent UTI, Recurrent Urinary Tract Infection

Advertisement

  1. Epidemiology
    1. Incidence of bacteriuria
      1. School age child: 1.2%
      2. Late Teenage years: 2-5%
      3. Additional 1% per decade of life
    2. Incidence of UTIs for those prone: 2-3 per year
      1. Reduced to <1 per year on prophylaxis
  2. Infection Classification
    1. General
      1. Reinfection represents 99% of recurrent UTI in women
      2. Vaginal colonization is the most common cause
    2. First Infection
    3. Unresolved Bacteriuria (Refractory Infection)
      1. Bacterial resistance to drug selected for treatment
        1. Resistance developed by sensitive bacteria
        2. Bacteriuria with 2 different species
        3. Rapid reinfection with a second resistant organism
      2. Azotemia
      3. Analgesic abuse causing papillary necrosis
      4. Giant staghorn calculi
      5. Noncompliance
    4. Bacterial persistance (Same organism recurs)
      1. Infected Renal Calculi
      2. Chronic Bacterial Prostatitis
      3. Unilateral infected atrophic Pyelonephritis
      4. Infected pericalyceal Diverticulae
      5. Infected nonrefluxing ureteral stumps
        1. Follows Nephrectomy
      6. Medullary sponge kidneys
      7. Infected Urachal Cysts
      8. Analgesic abuse causing infected papillary necrosis
    5. Reinfection (Urine cleared, but new infection occurs)
      1. Colonization of vaginal introitus
      2. Vesicoenteric fistulae
      3. Vesicovaginal fistulae
  3. Management: Urinary Tract Infection Treatment
    1. Single Dose
      1. Trimethoprim-Sulfamethoxazole DS for 2 tablets
      2. Sulfisoxazole 2 g
      3. Trimethoprim 400 mg
      4. Amoxicillin 3 grams
      5. Ciprofloxacin 250 mg - 500 mg
      6. Norfloxacin 400 mg
    2. Short Course (3-5 days)
      1. Trimethoprim-Sulfamethoxazole DS PO bid
      2. Sulfisoxazole 500 mg qid
      3. Trimethoprim 100 mg bid
      4. Amoxicillin 500 mg tid
      5. Nitrofurantoin 100 mg qid
      6. Macrobid 100 mg bid
  4. Management: UTI Prophylaxis
    1. Continuous UTI Prophylaxis (Average Course: 6 months)
      1. Nitrofurantoin 50 mg qd
      2. Trimethoprim Sulfamethoxazole 40/200 qd or 3x/week
      3. Cephalexin 125 mg qd
    2. Postcoital Prophylaxis
      1. Trimethoprim Sulfamethoxazole 80/400
      2. Nitrofurantoin 100 mg
      3. Cephalexin 250 mg
    3. Home antibiotics to start at first symptom onset
  5. Management: Prophylaxis with Cranberry Juice
    1. Daily cranberry juice prevents recurrent UTI
      1. Contains proanthocyanidin compounds
      2. Inhibits E. coli from adhering to urinary tract
    2. Recommended daily dosing of cranberry juice
      1. Cranberry extract 300-400 mg tablet bid or
      2. Pure cranberry unsweetened juice 8 ounces tid
    3. References
      1. Kontiokari (2001) BMJ 322:1571
      2. Howell (1998) N Engl J Med 339(15):1085
      3. Lynch (2004) Am Fam Physician 70(11):2175
  6. Behavior Modification
    1. Women should clean perineum wiping front to back
    2. Women should empty bladder before, after intercourse
    3. Avoid Contraceptive Diaphragm

Recurrent urinary tract infection (C0262655)

ConceptsDisease or Syndrome (T047)
EnglishRECURRENT URINARY INFECTIONS, RECURRENT URINARY TRACT INFECN, Recurrent urinary tract infection, Recurrent urinary tract infections, RECURRENT UTI, Recurrent UTI - urinary tract infection, URINARY TRACT INFECTION RECURRENT, URINARY TRACT INFECTIONS RECURRENT
Spanishinfeccion recurrente de las vias urinarias, infecciones recurrentes de la via urinaria
Parent ConceptsChronic urinary tract infection (C0262421), Recurrent disease (C0277556), Duplicate concept (C1274013), Ambiguous concept (C1274012)
SourcesCOSTAR, DXP, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



Navigation Tree