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How to Treat Urinary Tract Infection?


Medical Treatment:
Empirical treatment is indicated only if:
  • Positive leucocytes and nitrites on urine test strips, or
  • Leucocytes or nitrites with symptoms of UTI, or
  • Systemic signs and symptoms.
Alkalinising agents are not advised as many antibiotics require a lower urinary pH.
Uncomplicated cystitis
  • Ciprofloxacin, oral, 500 mg as single dose.
Complicated cystitis
  • Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
For pregnant women:
  • Amoxicillin/clavulanic acid, oral, 875/125 mg 12 hourly for 7 days.
Acute pyelonephritis
  • Admit all patients with vomiting, sepsis or diabetes.
  • Ensure adequate hydration with intravenous fluids.
  • If there is a poor response, perform an ultrasound on all hospitalised patients urgently as in-patients or electively as out-patients.
Adjust antibiotic according to sensitivity. Duration of antibiotic therapy:
  • fluoroquinolones 7 days.
  • other antibiotics 14 days.
Longer courses of therapy, 2-3 weeks, should be given for complicated pyelonephritis.
If normal renal function:
  • Gentamicin, IV, 6 mg/kg daily.
Switch to oral therapy as soon as the patient is able to take oral fluids:
  • Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
If impaired renal function:
  • Ceftriaxone, IV, 1 g daily.
Switch to oral therapy as soon as the patient is able to take oral fluids:
  • Ciprofloxacin, oral, 500 mg 12 hourly for 7 days.
    • CrCl: less than 10 mL/minute 50% of normal dose
Refer to a urologist if there is failure to resolve.