Shamaila Masood19/08/09

Sceanario 1 – Pt AA 25 y old woman presents with 2/7 history of

urgency. This is the first time she has had these symptoms

She uses a condom. Dipstick shows protein and leucocytes

True or False?UTI is the most likely diagnosis and MSU is

unnecessaryEmpirical therapy with amoxicillin is

appropriateA 3 day course of abx is sufficientThe patient should be encouraged to drink

water and teaIf the symptoms fail to resolve the most

likely explanation is the infection involves the upper urinary tract

True or FalseIn recurrent cystitis a MSU should be

obtainedRecurrent cystitis should always be treated

with 7-10 days abxRecurrent UTIs may be associated with

sexual activity

Sceanario 1 – Pt A cont…An MSU grow E.Coli resistant to

trimethoprim. Pt A completed her course of trimethoprim and now says she is symptom free and well.

Is a further course of the appropriate antibiotic necessary?

Which one of the following cause UTIs commonly ?E.coliStrep pneumoniaeStaph saprophyticusGroup A strepEnterococcus

In a woman presenting for the first time with symptoms of cystitis which is correctA urine dipstick is mandatoryThe presence of nitrites is suggestive of UTIThe symptoms could be cause by a STIA 5-7 day course of trimethoprim is neededDrinking caffeine improves symptoms

Recurent UTIs may be associated withSexual intercourseUse of spermicide-coated condomsAtrophic vaginitisDiabetesNo identifiable cause in majority of cases

Which abx are first line treatmentAmoxicillinAugmentinTrimethoprimCiprofloxacinnitrofurantoin

Management50 % E.Coli resistant to amoxicillinFirst Line

TrimethoprimNitrofurantoin

Second LineAugmentinCephalosporinsFluoroquinolones

Causes of Recurrent CystitisPost coitalDiabetesObesityChronic constipationReduced fluid intakeReduced voidingAtrophic vaginitisTampons!

When to send an MSUComplicated UTIDipstick neg but symptoms suggestiveRelapse/recurrent infectionPregnancySymptoms in the elderlyFailure to respondSuspected pyelonephritis

Sceanario 2 – Pt BA 26 y old woman presents for review at 10

weeks gestation.She has no urine symptoms.

True or False?She should be screened for asymptomatic

bacteraemia with a dipstickIf asymptomatic bacteraemia is detected the

risk of acute pyelonephritis during pregnancy is 10-30%

Asymptomatic bacteraemia during pregnancy should always be treated with antibiotics

Nitrofurantoin can be safely administered during the first trimester

ReferenceeModule on doctors.org.uk