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Urinary Tract Infection in Women
   

Urinary Tract Infection Women

Introduction

Lower urinary tract infections are among the most common infections in women, affecting about 40-50% of women at some time during their lives. There are over four million physician office visits each year for acute, symptomatic UTI in women at a national cost of around $300 million. Urinary tract infections are among the most common reasons for an ambulatory care visit for Humana adult members.

General Recommendations

1. Women with symptomatic lower urinary tract infection will generally present with symptoms of:

  • dysuria,
  • frequency,
  • and urgency.

2. Uncomplicated urinary tract infections occur in otherwise healthy individuals with intact voiding mechanisms and no evidence of other disease process.

3. Complicated urinary tract infections should be recognized as early as possible, as their treatment needs to be more aggressive than that of uncomplicated infections. Characteristics of complicated urinary tract infections include:

  • Known functional or structural abnormalities of the voiding system such as calculi, strictures, neurogenic bladder, indwelling catheter,
  • history of renal insufficiency,
  • history of urologic procedure in past two weeks (e.g., catheter, cystoscopy),
  • underlying chronic diseases such as diabetes mellitus, sickle cell, polycystic kidney, renal transplantation,
  • immunosuppression (e.g., steroids, chemotherapy),
  • pregnancy,
  • a history of recurring urinary tract infections (4 or more in preceding 12 months),
  • recent failure of antibiotic treatment for UTI (within the past two weeks).

4. The patient should be assessed for other possible GU diseases that may require different or more aggressive treatment than an uncomplicated lower urinary tract infection. The patient should be assessed for:

  • Acute pyelonephritis, characterized by fever (>101ºF), chills, flank pain, and leukocytosis

  • Urethritis/vaginitis, characterized by a urethral or vaginal discharge and/or a history of a new sexual partner in the prior three months or a history of contact with a partner infected with an STD.

Diagnostic testing:

1. If the patient has either a complicated UTI (see 3.0) or symptoms of other GU diseases (see 4.0) a urinalysis and hold for urine culture should be done and the patient should be seen by a provider for assessment and other possible examination and testing.

2. In uncomplicated UTI, a dipstick urine screen should be done to confirm the diagnosis when possible. If a dipstick urine screen cannot be readily obtained and the member and the provider are comfortable with the diagnosis of UTI, treatment may be initiated without testing.

3. A complete urinalysis and a urine culture are not necessary when treating uncomplicated urinary tract infection.

Treatment:

1. Short course therapy is appropriate for women with uncomplicated UTI where symptoms of other GU diseases are absent. In patients with symptoms of GU diseases this therapy may still be appropriate after they have been evaluated by a provider. Members given short course therapy should be advised to call back if their symptoms do not resolve or if the symptoms worsen at any point. Acceptable short course therapy agents include (in order of preference):

  • Trimethoprim 100 mg BID for 3 days
  • Trimethoprim/sulfamethoxazole DS BID for 3 days
  • Nitrofurantoin (Macrodantin) 100 mg QID for 3 days (do not give to patients with elevated creatinine)
  • Ciprofloxacin 100 mg or 250 mg BID for 3 days

2. For female members with complicated UTI or who are not suitable for short course therapy, antibiotic treatment should be given, generally for at least ten days. The most common acceptable oral agents for initial treatment and their usual dosage includes (in order of preference):

  • Trimethoprim 100 mg BID
  • Trimethoprim/sulfamethoxazole DS BID
  • Nitrofurantoin (Macrodantin) 100 mg QID (do not give to patients with elevated creatinine)
  • Ciprofloxacin 100 mg or 250 mg BID
  • Amoxicillin-clavulanate 500 mg BID

3. Additional agents that are commonly used in the treatment of UTI for susceptible strains of bacteria (resistance to these drugs is common) include:

  • Cephalexin 500 BID
  • Amoxicillin 250 mg TID