Lower Urinary Tract Infection Treatment

Urinary Tract Infection : Antimicrobial Prescribing

NICE guideline

This guideline sets out an antimicrobial prescribing strategy for lower urinary tract infection in children, young people and adults who do not have a catheter. It aims to optimise antibiotic use and reduce antibiotic resistance.

See a 3-page visual summary of the recommendations, including a table to support prescribing decisions.

• People with lower urinary tract infection, their families and carers

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Uncomplicated Cystitis In Nonpregnant Patients

Uncomplicated cystitis occurs in patients who have a normal, unobstructed genitourinary tract who have no history of recent instrumentation and whose symptoms are confined to the lower urinary tract. Uncomplicated cystitis is most common in young, sexually active women. Patients usually present with dysuria, urinary frequency, urinary urgency, and/or suprapubic pain. Treatment regimens for uncomplicated cystitis in nonpregnant women are provided in Table 1, below.

References

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Will A Uti Go Away On Its Own

Some UTIs can go away on their own. A 2022 article states that some uncomplicated UTIs can resolve spontaneously without treatment, but that some people need to see a doctor to relieve their symptoms.

A person should always see a doctor if they develop symptoms of a UTI as they can progress into a kidney infection.

What Oral Antibiotics Are Used To Treat An Uncomplicated Uti In Women

The following oral antibiotics are commonly used to treat most uncomplicated UTI infections :

• sulfamethoxazole-trimethoprim

Your doctor will choose your antibiotic based on your history, type of UTI, local resistance patterns, and cost considerations. First-line options are usually selected from nitrofurantoin, fosfomycin and sulfamethoxazole-trimethoprim. Amoxicillin/clavulanate and certain cephalosporins, for example cefpodoxime, cefdinir, or cefaclor may be appropriate options when first-line options cannot be used.

Length of treatment for cystitis can range from a single, one-time dose, to a course of medication over 5 to 7 days. Kidney infections may require injectable treatment, hospitalization, as well as a longer course of antibiotic, depending upon severity of the infection.

Sometimes a UTI can be self-limiting in women, meaning that the body can fight the infection without antibiotics however, most uncomplicated UTI cases can be treated quickly with a short course of oral antibiotics. Never use an antibiotic that has been prescribed for someone else.

In men with symptoms that do not suggest a complicated UTI, treatment can be the same as women. In men with complicated UTIs and/or symptoms of prostatitis are not present, men can be treated for 7 days with a fluoroquinolone . Tailor therapy once urine cultures are available.

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Patients Randomisation And Treatment

Women aged 18 to 70 years, who visited their general practitioner because of one or more symptoms or signs typical of acute lower UTI or self diagnosed symptomatic cystitis were eligible if their urine dipstick was positive for nitrite or leucocytes, or both. We excluded pregnant women and women with clinical signs of upper UTI such as fever , costovertebral pain or tenderness, rigors, and nausea or vomiting. We also excluded women with known or suspected anatomical or functional abnormality of the urinary tract and comorbidities such as diabetes mellitus, active gastric or duodenal ulcer disease or gastrointestinal bleeding, inflammatory bowel disease, severe liver dysfunction , coagulopathy , renal insufficiency grade 3 or higher , known congestive heart failure III or higher), psychiatric illness or dementia, inability to communicate in German or French, and any other serious comorbidity as judged by the treating doctor. In addition we excluded women with documented immunosuppression or hypersensitivity to one of the study drugs or a history of asthma, urticaria, or hypersensitivity-like reactions after consumption of salicylic acid or other non-steroidal anti-inflammatory drugs, as well as women with vaginal symptoms , bladder catheter in situ or during the past 30 days, recurrent UTI , antibiotic treatment during the past four weeks, or UTI symptoms present for more than seven days before visiting the doctor.

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What Is Feline Lower Urinary Tract Disease

Feline lower urinary tract disease describes a variety of conditions that affect the bladder and urethra of cats. Cats with FLUTD most often show signs of difficulty and pain when urinating, increased frequency of urination, and blood in the urine. Cats with FLUTD also tend to lick themselves excessively and may urinate outside the litter box, often on cool, smooth surfaces like a tile floor or a bathtub.

While FLUTD can occur at any age, it is usually seen in middle-aged, overweight cats that get little exercise, use an indoor litter box, have little or no outdoor access, or eat a dry diet. Factors such as emotional or environment stress, multi-cat households, and abrupt changes in daily routine may also increase the risk that a cat will develop FLUTD.

Major signs of feline lower urinary tract disease include:

• Straining to urinate
• Frequent and/or prolonged attempts to urinate
• Crying out while urinating
• Excessive licking of the genital area
• Urinating outside the litter box
• Blood in the urine

Note that cats with a urethral obstruction will also show these signs but will pass little or no urine and become increasingly distressed. Urethral obstruction is seen more often in males than female cats due their longer, narrow urethra. A urethral obstruction is an emergency and requires immediate veterinary treatment.

What Foods Help Regulate Low Blood Sugar

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How Relevant Is This To My Practice

Uncomplicated lower UTI remains one of the most commonly treated infections in primary care. The urinary tract is a common source of infection in children and infants and is the most common bacterial infection in children < 2 years of age, both in the community and hospital setting. During the first six months of life, UTIs are more common in boys. The outcome is usually benign, but UTIs can progress to renal scarring in early infancy, especially when associated with congenital anomalies of the urinary tract. Renal scarring may lead to complications in adulthood including hypertension, proteinuria, renal damage and even chronic renal failure, which requires dialysis treatment.

In general, 40% of women develop a UTI at some point in their life. In Singapore, 4% of young adult women are affected and the incidence increases to 7% at 50 years of age. Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode of UTI during their lifetime. It is reported that one in three women have their first episode of UTI by the age of 24 years. UTIs are most commonly seen in sexually active young women. Other susceptible adults include the elderly and patients requiring urethral catheterisation.

Check If It’s A Urinary Tract Infection

Symptoms of a urinary tract infection may include:

• pain or a burning sensation when peeing
• needing to pee more often than usual during the night
• pee that looks cloudy, dark or has a strong smell
• needing to pee suddenly or more urgently than usual
• needing to pee more often than usual
• lower tummy pain or pain in your back, just under the ribs
• a high temperature, or feeling hot and shivery
• a very low temperature below 36C

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Which Antibiotic Should Be Used To Treat A Uti

There are multiple types of antibiotics used to treat urinary tract infections . Different treatments may be recommended in different areas of the country based on regional patterns of antibiotic resistance.

Most patients with an uncomplicated UTI will begin treatment without any special diagnostic test, although a urinalysis may be performed by taking a urine sample. In a urinalysis, the chemical components of the urine are determined, and the doctor may look at urine color, clarity, and a view a sample under the microscope. A urine culture may be order, too, but is not always needed to start treatment. A urine culture can define the specific bacteria causing the UTI in more complicated cases or in the case of treatment failure.

Symptoms like burning and stinging while urinating will usually clear up in within one day after starting treatment. Be sure to finish your entire course of medication. If symptoms are still present after 2 to 3 days, contact your healthcare provider.

More extensive diagnostic procedures or imaging tests like an X-ray may be required if you continue to have frequent UTIs.

Condom Use During Sex

Non-lubricated latex condoms may increase friction and irritate the skin during sexual intercourse. This may increase the risk of a UTI.

But there are many reasons to use condoms. Theyre important for reducing the spread of sexually transmitted infections and preventing unwanted pregnancy.

To help prevent friction and skin irritation from condoms, be sure to use enough water-based lubricant during sex.

Avoid using condoms coated with spermicide.

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What Are The Causes Of Flutd

Urolithiasis

One possible cause of FLUTD is the formation of urinary stones, also called uroliths, in the bladder and/or urethra. These are collections of minerals that form in the urinary tract of cats. X-rays or ultrasound are usually needed to diagnose urinary stones. The most commonly seen uroliths are calcium oxalate and struvite . While a special, stone-dissolving diet can be prescribed to dissolve struvite stones, calcium oxalate stones need to be removed surgically. If the diet fails, or if the stones form again, then surgery may also be necessary for struvite stones. In female cats, it may also be possible for a veterinarian to help a cat pass stones by flushing its bladder with sterile fluids or remove small stones directly from the bladder using a cystoscope when the cat is under anesthesia. A veterinarian may then recommend medication or dietary changes after surgery to help prevent recurrence.

Urinary infection

Infection of your cats urinary tract with bacteria, fungi, parasites or possibly even viruses can cause signs of FLUTD. Although bacterial infections are more common than fungal, parasitic or viral infections, they are still relatively uncommon in cats. If an infection is found, your veterinarian will probably look for another disease or problem that may have put your cat at risk of infection. For example, uroliths and diabetes can increase the risk of urinary tract infection.

Urethral obstruction

Feline idiopathic cystitis

Other causes