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~ UTI ~
Acute Cystitis
- Pathogen:
- most common: Esherichia coli (80%)
- others: Staphylococcus saprophyticus (5-15%)
- Clinical Presentations:
- Symptoms: dysuria, frequency, and urgency associated with suprapubic or low
back pain
- Signs: suprapubic tenderness
- U/A: pyuria and sometimes hematuria
- Diagnosis: based on clinical presentations
- Treatment:
? The optimal choice: less
expensive
Bakar (Trimethoprium 80mg and Sulfamethoxazole 400mg)
160-800mg q12h, 或
Trimethoprium 100mg q12h both for 3 days
‚ The second choice:
fluoroquinolones
Tarivid (100) 200mg q12h for 3 days
Reserverd for recurrent infections, treatment failure, drug
allergy, resistant strain infections
Recurrent Cystitis
- Pathogen: exogenous reinfection (90%)
- Clinical Presentations:
similar to that in acute cystitis
- Diagnosis:
- should be documented by culture to rule out a resistant microorganism
- Treatment:
- continuous prophylaxis, postcoital prophylaxis, or therapy initiated by the
patient
when symptoms are first noted.
- Hormonal replacement therapy (orally or topically) for menopaused women
Urethritis
- Pathogen:
- Chlamydia trachomatis
, Neisseria gonorrhoeae,
or genital herpes;
- Occasionally Candida albicans or trichomonas
- Clinical Presentations:
- Symptoms: dysuria, which may be associated with abnormal vaginal discharge
or bleeding
- U/A: pyuria
- Diagnosis:
based on clinical presentations
- Treatment:
based on specific pathogen
Acute Pyelonephritis
- Pathogen: Esherichia coli (more than 80%)
- Clinical Presentations:
- ranging from Gram(-) septicemia to a cystitis-like illness with mild flank
pain
- U/A: pyuria, Gram(-) bacteria
- U/A
- Blood culture
- Diagnosis:
based on clinical presentations
- Treatment:
Ÿ in the absence of
nausea, vomiting, and severe illness: outpatient oral therapy
Bakar (Trimethoprium 80mg and Sulfamethoxazole 400mg) 160-800mg
q12h, 或
Tarivid (100) 200-300mg q12h for 3 days, both for 10-14 days
Ÿ in the presence of
pregnancy, nausea, vomiting, and moderate to severe illness: hospitalization
Rocephin (0.5) 1-2g qd iv
Ampicillin (0.25/0.5) 1g q6h
Gentamicin
或
Aztreonam (1) 1g q8-12h
- Symptoms should resolve after 48-72 hours.
If symptoms persist after 72 hours of therapy, sonography
of CT should be considered to rule out a perinephric or intrarenal abscess
or ureteral obstruction
- A follow-up culture should be obtained 2 weeks after the completion of
therapy.
Filename: UTI
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