Relapse : A consecutive urinary infection caused by the same strain or serotype of bacteria, usually represent infection of the kidney or prostat, often recur within 1 6 weeks after antimicrobials have been discontinued, some cases represent persistent infection, anatomic abnormalities or renal insuficiency are more common with relapsing or persistent infection, a long course of antimicrobials or surgery may be required if the urine is to be permanently sterilized
Recurrent UTI: patients with at least two infections within 6 months or three or more during a single year, in which the initial episode is resolved and is followed by another infection.
2. Urinalysis
The presence of 10 WBC / mm3 fresh un-spun midstream urine The presence of 10 WBC / high-power field sediment midstream urine
Asymptomatic patients :
105 pathogenic organism/ml urine in two consecutive samples
No investigation
Moderate severity
Severe illness
Hospitalization with initial parenteral therapy (trimethoprimsulfametaxazol, ceftriaxone, quinolone, gentamicin with/without ampicilin Urologic evaluation
No resolution in 5 days
Resolution in 5 days
Treatment 14 days
Yes
5 Days
Switch to or continue oral regimen For total 2 weeks
No
Review antimicrobial susceptibility pattern Radiologic & urologic evaluation Correct reversible risk factors
Review treatment plan as appropriate, treat for total 2 weeks or longers if necessary
Relapse
Diagnosis
Reinfection
3 year
2 year
Sexually active
Postmenopausal
Estrogen substitution (oral & topical) Antibiotic therapy : On demand or Longterm prophylaxis
Madersbacher S, et al. Curr Opin Urol 2000 ; 10 : 32.
Drug regimens for long-term, low-dose prophylaxis of recurrent urinary tract infection Drug
Nitrofurantoin Trimethoprim Co-trimoxazole Norfloxacin Ciprofloxacin Cephalexin Hexamine hippurate
Dose*
50 mg 100 mg 0.24 g 200 mg 125 mg 125 mg ( useful if renal insufficiency) 1g
* Treatment is effective if taken each night, alternate nights, three times a week, or just after intercourse
5. Asymptomatic bacteriuria
Possible
Diabetes mellitus Short-term indwelling catheterization Intermittent catheterization
Not indicated
Elderly School girls and premanopausal women
Renal transplant
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