Treatment Of Uncomplicated Urinary Tract Infection

A 20-year-old otherwise healthy woman presents with cloudy urine, burning on urination, and urinary frequency. The patient has no allergies.
Physical examination shows the patient is afebrile. She has mild suprapubic pain with palpation but no costovertebral angle tenderness.
Urinalysis is positive for nitrites and leukocyte esterase. Which of the following is the most appropriate treatment?

A) Hospitalize the patient and administer intravenous antibiotics.
B) Administer macrolide-containing antibiotics on an outpatient basis.
C) Administer sulfa-containing antibiotics plus phenazopyridine (Pyridium) on an outpatient basis.
D) Advise the patient to increase fluid intake, especially with cranberry juice.
E) Arrange for an intravenous pyelogram.

Answer:



C.  Administer sulfa-containing antibiotics plus phenazopyridine (Pyridium) on an outpatient basis.

Explanation:
Urinary tract Infection: UTIs are more common in sexually active women.
Symptoms include :

• dysuria,
• urinary frequency, 
• enuresis, 
• incontinence
• suprapubic tenderness, 
• flank pain, or 
• costovertebral angle tenderness (which usually indicates pyelonephritis). 

Etiology: Gram-negative bacteria that originate from the intestinal tract (i.e., Escherichia coli, Staphylococcus saprophyticus, Klebsiella, Enterobacter, Proteus, Pseudomonas) are usually the causative organisms.

Diagnosis is accomplished by microscopic or dipstick evaluation of a clean-catch midstream urine sample. Urine culture confirms the diagnosis.

Treatment is oral (and in most cases sulfa-containing) antibiotics. With no complicating clinical factors, reasonable empiric treatment for presumed cystitis before organism identification is a 3-day
regimen of any of the following: oral TMP-SMX, TMP, norfloxacin, ciprofloxacin, ofloxacin, lomefloxacin, or enoxacin.
With complicating factors of diabetes, symptoms for more than 7 days, recent UTI, use of diaphragm, and postmenopausal women, a 7-day regimen can be considered using the same antibiotics. Phenazopyridine hydrochloride may be necessary for 1 to 3 days if significant dysuria is present. Affected patients should also be encouraged to increase their fluid intake.