Acute CYSTITIS/URETHRITIS

Clinical Description

Acute cystitis is an acute inflammation of the bladder. Women are affected 10 times more than men due to the shortness of their urethra compared to that of men. 40%-50% of all women will develop cystitis in their lifetime.

Signs and Symptoms

• Dysuria, frequency, urgency, suprapubic discomfort, hematuria, smelly urine.

Investigations

• Full blood count
• Urine dipstick and microscopy
• Urea and creatinine

Treatment

Objectives:

• To eradicate infection
• To prevent recurrence and complications
• To relieve pain

Note: Think of Bilharzia; Diabetes Mellitus and cancer of the urinary bladder also in patient with similar presentation and symptoms are recurrent

Non-pharmacological

• Ensure adequate fluid intake of at least 2L in a day
• Encourage frequent voiding, especially patients with recurrent infections

Pharmacological

• For acute uncomplicated (all non-pregnant women, symptoms duration less than 1 week, not men or catheterized patients) give Ciprofloxacin 500mg 12 hourly for 3 days

Alternatively

• Give Nitrofurantoin 100mg 6 hourly with food for 5 days
• Or Cefuroxime 500mg 12 hourly for 5 days
• Consider urine microscopy, culture and sensitivity if no response or recurrent infections to guide treatment

COMPLICATED URINARY TRACT INFECTIONS

Clinical Description

• Includes men, pregnant women, catheterized patients, patients with abnormal urinary tracts and those with symptoms > 1 week

Treatment

• Give Ciprofloxacin 500mg orally 12 hourly for 5 days or
• Give Co-amoxiclav 375mg 8 hourly or 625mg 12 hourly for 7 days

Alternatively

• Give Gentamycin 240mg IM or IV STAT
• Followed by any of the above oral antibiotics
• Consider urine microscopy, culture and sensitivity to guide treatment if no response to above treatment or recurrent infections