From the Guidelines
Urinary Tract Infections (UTIs) are typically characterized by symptoms such as dysuria, frequent urination, and abdominal pain, and can be treated with antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin.
Symptoms of UTI
- Dysuria (painful urination)
- Frequent urination
- Abdominal pain
- Fever
- Cloudy or strong-smelling urine
Treatment Options for UTI
- First-line antibiotics: nitrofurantoin, TMP-SMX, or fosfomycin, chosen based on local antibiogram and patient allergies 1
- Duration of treatment: generally no longer than 7 days for uncomplicated UTIs 1
- Self-start antibiotic therapy: can be considered in reliable patients who are willing to obtain urine specimens before starting therapy and communicate effectively with their provider 1
- Prophylaxis: may be considered for women with recurrent UTIs, defined as 2 or more symptomatic episodes in 6 months or 3 episodes in 1 year 1
Prevention of Recurrent UTIs
- Self-care measures: ensuring adequate hydration, encouraging urge-initiated voiding and post-coital voiding, avoiding spermicidal-containing contraceptives, and using topical vaginal estrogens in postmenopausal women with risk factors 1
- Imaging: not routinely recommended for patients without underlying risk factors, but may be indicated in patients with recurrent UTIs or complicated UTIs 1
From the Research
Symptoms of Urinary Tract Infection (UTI)
- Change in frequency, dysuria, urgency, and presence or absence of vaginal discharge are the most diagnostic symptoms of UTIs 2
- UTIs may present differently in older women 2
- Symptoms can range from simple bladder inflammation to severe cases of uroseptic shock 3
Risk Factors for UTI
- Female sex, history of prior UTI, or the presence of a urinary catheter or other urinary tract abnormality can predispose to disease 4
- Biological sex, age, menopause status, and diabetes mellitus are common risk factors for recurrent UTIs (rUTIs) 5
Diagnosis of UTI
- Dipstick urinalysis is popular for its availability and usefulness, but results must be interpreted in context of the patient's pretest probability based on symptoms and characteristics 2
- Urine culture is the gold standard for detection of urinary tract infection 2
- Nitrites are likely more sensitive and specific than other dipstick components for urinary tract infection, particularly in the elderly 2
Treatment Options for UTI
- The current clinical paradigm for the treatment of UTIs involves the use of antibiotics 4
- First-line treatments for urinary tract infection include nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole (when resistance levels are <20%) 2
- In pregnancy, beta-lactams, nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole can be appropriate treatments 2
- Long-term antibiotic prophylaxis, estrogen hormone therapy, and dietary supplements are also used as prophylactic strategies for rUTIs 5