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A 76yrs old debilitated male ,in extended care facility develops every 6months mild fever,frequency of micturation with urinary incontinence.Urinary E.coli is >100,000,
what is appropriate treatment.
A.Cystoscopy and IVP
B.Continous lowdose antibx
C.Cathetrize n irrigate bladder
D.treat only acute episode of infection.
E.NO need of treatment as this is colonization.
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D, definite answere bc it is not a recurrent UTI...MORE THAN 3 EPISODE IN A YR OR 2 IN 6MOS IS A RECURRENT UTI THAT REQUIRE LOW DOSE ANTIBIOTICS. ANSWER B IS WRONG
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D seems good. But in a male, getting frequent UTI, wouldnt you want to do IVP and see whats wrong?
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Yes, I found that recurrent UTI is three times a year.
Prophylaxis is different between male and female.
For male,
Prophylaxis
A Cochrane review concluded that neither the possible benefits e.g. prevention of urinary tract infection, or prevention of renal damage, nor the risks e.g. adverse effects or bacterial resistance, of prophylactic antibiotics had been adequately evaluated.13
NICE Guidance does NOT advocate the use of routine antibiotic prophylaxis.5
Relief of voiding dysfunction, good hygiene, wiping from front to back after micturition in girls, avoiding constipation, bubble baths, chemical irritants and tight clothing are sensible recommendations.
Children with significant urinary tract abnormalities and/or frequent symptomatic UTI may benefit from prophylactic antibacterials (trimethoprim or nitrofurantoin).14
Clinical Knowledge Summaries suggest that children who suffer a second UTI within a year should receive short-term prophylactic antibiotics and be referred for their assessment for long-term use.4
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Women
Relapse:
Treat with antimicrobial for 3 days and refer if persists.
Reinfection:
Treat each recurrence with antimicrobial for 7 days and consider prophylaxis if (3 episodes per year).
Prophylaxis:
If not related to sexual intercourse then consider either nightly or 3x a week antibiotics from above, possible up to 5 years.6
Consider trial of cranberry juice.7,8 Optimum dose and method of delivery has not been determined.
If related to sexual intercourse:
Change contraceptive method if diaphragm or spermicide being used.
Advise voiding after intercourse.
Suggest using a lubricant.
If more than 3 UTIs/year consider prophylactic antibiotics taken
