hae Fal, Pains, 0 ania M.A, MO Lan pet Neots, ical Practice Gudelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2014 Update Asymptomatic Bactetiuria and Recurrent Urinary Tract Infection #Q@e0Asymptomatic Bacteruria in Adults - Screening and Treatment Defeiton > Foranymplomate wore, bacterin is defined 9 wo cansecutne ‘olde une specmens mh oiston of he same bli stain ‘arta couns 2 10,00 tum. ‘Srangecemmendator, High quality of ovdenco > Inmen,asnge, clean catch voided urine specimen with ne baci Species elated In a quontatve cout "100,000 cfm. Mentos eterna ‘Strong recommandston High quay evtserco > nto man and worn, a singe catetorzed wine specimen with ‘ne taco speses aad n'a quaniatve count» 100 cu. ‘Song recommendation, High ualy of evsence + All diagnos of asymptomatic acters shuld be base on ost (ui care spocans tat recalled asopcaly 8 with no ‘dence of contamination. ‘Seong recommendation, High quay of evidence {ndcatons fo serening and eatmen > Screening and. reainent for asyrglamatc bacensla recommended in heal: (2) Al pegnant women, ‘Stong recommendation, High quay of evtence (Raton wy wil unde genta manpuson cr ‘Song recommends, High quality of evidence ‘casa nner scaring and weament or systema bacenuis NOL indeatos > Routine screening and toatnant er asymplmats bara snot recommended fo heathy ads ‘Song recommender, Low qual of evidence > Lhawiso, gerade screening and westrent for asymptomatic oserisia na recommended thealewng (a) Potons wi dabtes metitos ‘Stongeconmendon, Moda uty of edn (©) eat patente ‘Seong recanmendstn, gn gut dence (©) Patonts wen nding eaters Weak reconmendator, Low quality of evdence xcept inthe folowing specs popustons (1) Pregnant patients ‘Strong recormenston, Moderate quaityoferdonce (2). Those who wil undergo waloge procacies ‘Song recommandln, Mecha uty of erdonce (3) Those whose tactrat sgents caise Nigh incidence of Dacteromian Beir nttsion Weak recemmandaen, Low gun of users (4), Nowopenic patents Weak secommendadn, Low quay ef toros (6) Those that may be part of a infection ental plan to ‘manage custrhfectons na unt ‘Weak reconmmendan, Low aval of vere (4) Said ongentaepa patents ess an eng eset preset Weak reconmendation Low gvaty ef evdorce (@) Hiv patents Week recormendaton, Low quay o evidence (0) Spina cor ary pation ‘Song recommendation, Low quay af evdence (9) Patents win uroige abnormal Weak recommendation Low uaty of vdorce Semorina its Screening by urine culture recommended Be eee Gig tn he shone o ites fr urna cue, st ya 10 bore ora postve gram san of unspn vee 2 merorpais ‘f) intwo conesouvea mdateam une spl can bo esed 1 ‘Seon br soyrpteratc bac, “Stong recommendation Low qual fence ie uy rent wang a tae ate a ‘Stang econmmanaaton, Moderate omy of evince aria acompanying asymptomatic bac ¢ ro an indcaton for enamzobat tesinent among pateis fr whom Sceorng and {regmert isnt raaanendea. ‘Seong reconmendaten, Low qual of evdence>> The choca of antbiotie cepends on cle resus A sevencay region ie orammenss ‘Song recommendation, Low quay of evdonce > For specie recommendations on pregnant women aro Table 1 fd the secton en Ulin Pregnandy ‘Table 1. Antibiotics that can be used for asymptomatic bacteriuria in prognancy Patient with NO sensor eymptoms [ Nonseator tae eae ee eed eee | a cane conween —[somgeb Teen [8 Saeoatoee [soresno Teo |e = ‘Fosfomycin 2g single dose 8 ‘Screen for ASB aa rsa tr Gostrom "| EES sone eC = reaeey | Bae, | pietioal acne SESE. ny camrnae = Seman Synsope, ASD, Se (oot svsaste lot) | Scan econ Sr oF ‘rests AOS. Use ne fet tester pregnancy Isapproprate won roster natate Reina ites sonata) Tuono, | soo mg BD eT | Caen and Sihocat | days? feosDion > Recurrent UT! diagnosed when a heathy non-pregnant woman ‘ith no known nary rect abnomaes Nea 3 or re eplsodos of ‘Seu uncomplestd oystte documented by wine elie Sing 2 ‘T2monthporod OR 2 or mor episodes na Bmonth peed. > Rocatet UTI may other be lapse or a rltecton, © Relapse occirs wen the iil organiam persist win the win tact and reemerges dese adequate estment usualy ‘conan 1-2 weak afr sopping ratmant © Renton occurs when recurrent UTIs causod by a eiferont Doctoral elt, or by th previously Isat bacteria air 2 nogatve teeing culture or an adoquate period (= 2 weeks) etwsen octane Soxeeing > Routine scooning for usage abronmaiis rt recommended for the goer! palo peputon "Srey rectal, Low quay of etence > Screening for uciogic aormaliis recommenced int lowing Sessions (2) No respense to spproprste antimicrobial therapy or rapid ‘elapse ter auch terapy (©) Gross hematuria during a UT episode or persistent microscopic Sonata (6) Obeructve symptoms (3) Cinal inpeession of pesstent wtecton (6) Infection with ureaspting bacteria (Prseus, Mogan, Prowaenca) 1) History of pyeloneptis |g) History of orsymptoms suggestve of wolthiase 1h) History idhoot UT 10. Blevated serum creatinine Diasnascs > Radiologic oc maging stcles and cystoscopy ae not outhely Indeated i pats ath tecarer UT Weak econmendaton, Low ually of vience > Renal ulasound or CT scanstonogram may be done to screen for UWologe abnomaties ‘Stang econmendaten, Low quale vtenco > Patents wih anatomical abnormalities shoud be refead to 8 gest nepllogat or urlog for feher evehaon, ‘Soong recommendation Low gual evsonceroot > Proohylads fs recommended in women whosa_froquncy of feeence is'nt acceptable othe paont in trms of lovl of > Prophlais may be witheld acorsng to patent preference the frouaney of recuranca lerabie to the pont, ‘Song recommendation. Low gully of endonce > The folowing foctrs shoud guide the physician in detrmining the polenta tek bereft prof and in decug which prope Ste wl bo uso fa} Frequeney and pater of ecurences 18) Patents Mes, compliance and wiingness fo commit Yo 8 speafe rgman (6) Plans fora pregnancy |e) Antimicrobial resistance and susceptbity pater of the ‘organisms causing the pation previous UTI le) Riko adores ovets and drag alergios bit roots > Antti poohyfass should ony be nated after coursing and betavor modteton nave Deon atompted In ede fo minimize nti exposure and pss adver eos ‘Stang recammendeton Low gual of edence > Aatboti propyl shoul be itd o women wth racurent UT ‘n'vhom nowantimiraba stages have nt boon foci and “tha pater propifocte ankmcrasal heap ‘Srongrecammendaton, Moderate quay of ewtence > Wasecisiongmadetogve abit rophytaxs, any of he lowing [el Continuous prophylaxis, etna as te daly intsko ofa ow. owe of antbote'8 12 onthe ‘Stony recenmendalon, Moderte quot of once (6) Posto prophylans, dena aw aka of gle cose ‘iba inmedely ata sexual intercourse ‘Song recanmendatin, Moderate uty of endence {Interment prophylaxis, defines as settveatnent wih 9 ‘Shale anttiece dose based on patent's paced ned ‘Weak econmendston, Low qaly of dence + Any of te abies in Table 2 gan ether continuously for 6 to 12 monte o as fost-colal ropa can reduce be cca! end microbiologic recrenes f UTI epodes. ‘Story rcarmendton, Moderate quay of edocs ‘Table2, Antibiotics proven effective in reducing the number of recurrences of UT Narcurann | 50400mpat [50-100me [50mg oaime! a eaime Tizenoprin- | dOmgi200 mq | 40mg200 mq | 40 mg00 mg itanatonacos | dt sosime Tigaiaprn | dng200m9 | sO mae00 Mimosa | Sea"? | Pmaseo me Gpretoace | iasmgat | i2my | 1asmq bosine Norton [20omgat [200mg | 200m9 esi [Stoves 007mg Petxaan [00mg woah Catalonn Tasz50mgat | 1252500 Cotacr 2aimgat 20m Foslonyain Amoi 500m Ceroxme 250 9Matnanamin sts + Memenamin higpua my be ute as an tet io aniics tor shortarm propyl fone week) to preven UTI patnis ‘witout uray tat abrormalies Woak commandate, Low quay of ence ‘Behavioral measures in peswetecuten IT > Betavoral measures can be use antimirebia-sparng measures Ine prevention of recuret UT Weak recommendation, Low qual of eldence > Those behavior measirs incluso the following: (a) Post tefoation and anal cleansing aiero-posterer in women ‘0 avoid contaminating te parr aoa wth foal fora (8) Pstental douche or postctaluinaton (6) erat uid tae espcially ater ntrcouse |e) Avoidance o egetting underwear |e) Use of stare farm of conracepton for women ung spormcide-contanng conracopves Biloic meditrs. A Lactose > Laclobscit ath in eal fom and vagal suppostaris ce not Fecommened i tho prevenion of UT. ‘Steng raconmendator, High quay of endence 8. Cranbory products > Crabany ce and exanderry products can be used among patents wrain ongorm ambiote prepa for recurent UT1's ceomot nocosary to avod orrgoncs of ota of fecaland.unne wastes of Ect metoprin,mron a Speaioan, > Therecommonded dose fr UTI proventons day consurpton oF-900 mi of cranberry pace ocx of 500 mg capes antag 95mg PACs) taken ce a day a he anh aghast Satay decreases over timo. ‘Stong recommendation, Moderate qual of evidence Table 2. Avaliable cranberry products Inthe Piping = Crenbites 10 gy | PotSO Coe (Fuvrebiotcs) mye Pacs) tacos Gari [Grantors | S00m9 BX pore | PA0010 cane Mat wm |estec™ | Sided Grarbory | Grarbary | 5600 mp 700 mg_| PaT0}0 cane fencarcate | Sincaneate | 5:1 xt whole row wey | ymin Bio Cantor | ranbory | S00 ma Pane ei Fa Pomer Forgna | Gan 1S Pea raver juice | Viemn ‘Hormonal nansotons oc ost-menonsuss women. ‘ppkcation of irravaginal est cream once ach night for 2 Mocks folawed by hwico-woeay apps fa ast 8 fronths OF us of an esvasoleleasngsaconevaial tng ot $month recommondod fer he poverdon of racurent UT potemenopasal wen ‘Stony recommendation, Moderate quality of evidonco However, evidence le Insult to reconmand_ vagina ‘trogen ovr anes fr to proven frost UT Lowsose al esbogen i not recommended forthe prevention recurert UT. Cel estogers were assodated wit coonary fret sense, venous fvomboembaism, sake and becast ‘Strong econmendaton High quay of ewdercoImmsoomotysss. > Immunopresylnis, using, immune-sctne coll factions {Urowmuml tc reconnected fr Be prevenion of recueal Gn sing regan i cnoe daly PO tors manne ‘Stongrecxmmandaton, Moderate quality of endenco > ‘longedesendd dosing egman (nce ey for months, ret for3 mont, 10 days par month Yor 3 mnt and reat for 3 Ion) may be assocsted wih @ betor convo} ot ocurence Inthe eget, Weak recommendation, Moderate quality of evince cup > Aeupuntus on te lower abso, bak o lor extroios may be wid as an ateratve for prevention of recarert UTI "mong wonen when ante prophyane is confandicted "Seong reeammandaton, Meco aly of gence ‘Seal sation > ut wate ation 25 Lit) maybe done 1 prevet Weak recommendation, Low ql of evidence Consider femitent sltadminstored therapy in_ gh Siucated, Webinfomed. metvated paints, wherein the patents re abo fo rocognza the chats ss ae jms of UT). ae complant wth mesa! nsrstane ae have a god reatonsip wit a medial proder ‘Steng recommendation, Moderate quay of esdence > vital episodes of UTI in women wih rocurent UTI or ‘raktvough infections during propyl ‘can be tested fempraly neh any of he onbios recarmended for ac “incomplestd estes (Table 4 the than he antbote being ‘gron for proptyans. Aways rquost fora urine ule and ‘moaly the wearer acorn "Sang ecommendaton, Maderate quay of eisence Non sharmacoloicitaventions > Crary joe and cranny products ar not recommend ‘orth stant ot unary tet action ‘Song recommendation, Low quay of exdence 1 Thre no svnlable evidence to recommend coconut ce fe Table 4 Antbotes for acute uncomplicated cysts Prmary | Nitotuancin menohyaate, | 100 mpBIO for days PO Imacroceaa fot 0 tocty) ee Re ee ED ‘Aen |Prmecinam 100 ng 3 aHAPO (roteadteesty Otoxacn 200 ngBID fr S days PO Opretoxacr 230 mgBlD for $ days PO ‘hprofoxacnananded | 500 mgOD ford ays PO Levoforac | 250 ng0D tors aya PO. Norforacn $00 mg81D for 8 days PO ‘Amowietin avuaraie | 625 maBID fr 7 days POTable 5. Stronath of recommendation and Quality of Evidence Cetera rat 2st BID rT eayaPO ‘etaclor 200,nq TD ior days PO Cota 200/ng BID or aya PO Ceteacoxime prot | 10. BD or? ay PO ‘Sung Cetin 200 mg BD or days PO Wiesk ‘Desileand undessle eects cosy ‘NEY | Teton 60200709 81D fers baarcedor uncon ann | sutaranazi naP-skx) | days PO. proaltl Hon Consett evens tor we: parormad RCTS er exceptenaly song evince om urlased bsowatenal tas Nowa vidnoofrom ACT wih krpertant iaons ormedoaayareng eveonea rom urbased Soeoratuna sta Tow visnoe trom > one oitealaueome rom bees tices rom RCTs wh serous wor om not vio Vor tow vinoefer = one ciel extcome rom uneysorat cncal observation oF very neck lewderoe Sources: “Tesk Force on Urinary Tact lection, Pilppine Practce Guideline Group infecious Disease. Phiipane Cina Pacice Guanes on the Diognosr and Management of Unnary Tact fection in Adis 2013 Upasio. Quozan City, Phigones: PPGGO Phipine Sod fr ‘Merobogy ae Inorious Osea. 2013, ‘Guyat GH, Orman AD, Vt G=, Kunz R,Fak-Yer , Alonso‘Coato Schunemana Hu, GRADE Nothing Group. GRADE an emerging ‘noms on ating quay of once an strength of recommendatons. ‘Bl 2006 5° 120-806 Guyat GH, Osman AD, Kunz R, FaldcYor¥, Vist GE, Libera A ‘Schunerann HJ ad rhe GRADE Werkig Group. Gangtfom evidence