Uncomplicated Urinary Tract Infections

Overview: One of the most common diagnoses in the US with ~50% of women experiencing at least one infection during their lifetime and ~25% experiencing recurrent infections. E. coli is the most common cause of uncomplicated UTI, comprising 75-95% of infections. Other pathogens include S. saprophyticus, Klebsiella, and Proteus.

Common symptoms of acute uncomplicated lower UTI: dysuria, frequency, urgency, suprapubic pain/tenderness, hematuria. Fever or costovetebral angel tenderness indicates upper urinary tract involvement.

Diagnosis: 1) For women without a history of a laboratory-confirmed UTI, an office visit for urinalysis or dipstick testing is appropriate. Dipstick positive for leukocyte esterase/nitrates in a midstream-void supports diagnosis of UTI. Urinalysis not usually necessary unless a patient fails treatment. 2) Women with frequent recurrences and prior confirmation by diagnostic tests who are aware of their symptoms may be empirically treated

Treatment:1) TMP-SMX 160/800 mg BID for 3 days; not recommended in areas where local resistance rates exceed 20%, becoming an increasing problem in the US)2) Ciprofloxacin 250 mg BID for 3 days or Ofloxacin 200 mg twice daily; fluoroquinolones not first line because of resistance concerns3) nitrofurantoin monohydrate/macrocrystals (100 mg BID for 7-10 days)4) fosfomycin trometamol (3 g powder single dose)5) Cephalexin 250 mg 4x/day for 7-10 days; can increase risk of vulvovaginal candidiasis, also pregnancy category B

7-10 day treatment in postmenopausal women and men

Prevention of recurrence (≥2 UTIs in 6 mos or ≥3 UTIs in 12 mo): continuous antimicrobial prophylaxis for 6-12 monthspost-coital prophylaxis (single dose)patient-initiated self-treatment (3-day course).

If symptoms do not improve within 48 hours, women should contact their provider for a clinical evaluation. Can use nitrofurantoin, TMP, TMP/SMX, and fluoroquinolones. SOGC also cites cephalexin; ACOG also cites fosfomycin tromethamine.