Urology  |  Recurrent Urinary Tract Infection




Urology

Recurrent Urinary Tract Infection

Urinary Tract Infection in Men:

  • Refer only after the 2nd urinary infection if UTI uncomplicated i.e. no fever or flank pain.
  • Investigations:

    • DRE
    • MSU
    • Serum Creatinine
    • Order Renal Tract USS

Urinary Tract Infection in Women:

Behavioural modification important:

  • Fluid intake
  • Treat constipation
  • Void after intercourse
  • Cranberry juice
  • Probiotic yoghurts
  • Ovestin cream if perimenopausal may be helpful

While the evidence associated with these measures are not strong, they can be helpful.

If UTIs persist order a Renal Tract USS:

The criteria for a funded Renal USS scan are:

  • > 3 documented UTI's in 6 months, or 6 in a year despite adequate courses of culture specific antibiotics. This pattern implies bacterial persistence rather than recurrence. (Ensure that patient has not previously been investigated with imaging)
  • Recurrent pyelonephritis with no previous imaging.

If USS abnormal refer.

If USS normal:

  • Take a single dose of antibiotic after intercourse, if this is the precipitating factor.
  • Self-start treatment – women have relevant antibiotics with them to start as soon as symptoms of a UTI develop.
  • If the UTIs are multiple, or frequent, or severe consider a short duration (6 weeks ideally, but up to 3 months) of antibiotic prophylaxis. Use a low dose, culture appropriate agent.

Note: prophylaxis should be a last option, when all other measures have failed. Avoid if at all possible. The obvious risks of prophylaxis are selection of resistant bacteria, as well as significant and irreversible side effects related to long term use of particular antibiotics (e.g. pulmonary fibrosis with Nitrofurantoin).



Last updated : Friday, August 21, 2015
Next review date : Saturday, August 20,2016


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