From the Guidelines
If you have hematuria with UTI symptoms, you should seek medical attention promptly and treatment typically involves antibiotics such as nitrofurantoin (Macrobid) 100mg twice daily for 5-7 days, trimethoprim-sulfamethoxazole (Bactrim) DS twice daily for 3 days, or ciprofloxacin 250-500mg twice daily for 3-7 days, depending on your specific situation and local resistance patterns 1.
Key Considerations
- Hematuria can be a sign of a urinary tract infection (UTI), and prompt treatment is essential to prevent complications and improve quality of life.
- The choice of antibiotic depends on the severity of the infection, local resistance patterns, and patient-specific factors such as allergies and medical history.
- Increasing fluid intake can help flush bacteria from the system, and over-the-counter pain relievers like ibuprofen or acetaminophen can help manage discomfort.
- Phenazopyridine (Azo) can specifically relieve urinary pain but will turn urine orange-red.
Evaluation and Diagnosis
- The initial evaluation of hematuria should include a thorough history, physical examination, urinalysis, and serologic testing 1.
- Patients with suspected urinary tract infection as a cause of microhematuria should have urine cultures performed, preferably before antibiotic therapy, to confirm an infection.
- Patients with a suspected cause of microhematuria, including interstitial cystitis or benign prostatic hyperplasia, should have the appropriate clinical workup before undertaking imaging.
Treatment and Management
- Completing the full antibiotic course is essential even if symptoms improve quickly.
- While mild hematuria often resolves with UTI treatment, persistent blood in urine after completing antibiotics warrants further evaluation to rule out other conditions like kidney stones, bladder cancer, or kidney disease.
- All patients diagnosed with microhematuria should undergo a thorough history, physical examination, urinalysis, and serologic testing prior to any initial imaging, and many patients should undergo cystoscopy in addition to any imaging evaluation 1.
From the Research
Hematuria and UTI
- Hematuria, or blood in the urine, can be a symptom of a urinary tract infection (UTI) 2
- UTIs can involve the lower or upper urinary tract and may be uncomplicated or complicated 2
- The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation 2
Treatment of UTI
- Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens 2
- Antimicrobial resistance continues to increase and can complicate treatment choices in certain areas 2, 3, 4
- Trimethoprim-sulfamethoxazole, nitrofurantoin, and fosfomycin are all appropriate first-line therapies for uncomplicated cystitis 3
- Fluoroquinolones are effective for clinical outcomes but should be reserved for more invasive infections 3
Risk Factors for Resistance
- Prior use of fluoroquinolones, prior resistance to any studied antibiotic, and diabetes mellitus are associated with increased risk of resistance to certain antimicrobials 4
- Birth outside the U.S.A. and prior trimethoprim/sulfamethoxazole resistance are associated with trimethoprim/sulfamethoxazole resistance 4
- Pregnancy is protective against multidrug resistance 4