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Urinary Tract Infection



- UTI in the Spine Injured Patient

 Management:
   - Rx with ATB's, pending urine culture
   - Consider single dose therapy for symptomatic non-pregnant women with no known anatomic abnormalities;
   - Follow up culture in 7 to 14 days;
   - Prolonged therapy (7-10 days) is for symptomatic men, pregnant women or patients with symptoms of upper UTI, patients with renal disease or obstruction, and children;
   - Determine drug allergies;
       * Uncompicated UTI:
            - TMP/SMX: (160/800mg) bid PO x 3 days;
            - Augmentin;
       * Single Dose therapy:
            - Amoxicillin 3 gm PO
            - Sulfisoxazole 2 gm PO
            - septra 320/1600 mg PO
       * 7 - 14 day Therapy:
            - Sulfisoxazole 2 gm PO then 1-2 gm PO qid;
            - septra 160/800 mg PO bid;
            - Amoxicillin 250 mg PO q8hr;
            - Cephalexin 500 mg PO qid;
  * Note: the presence of bacteria in ea high power field of urine suggests the prensence of UTI the presence of > 8 WBC per HPF suggests UTI;
- acidification of the urine enhances the effect of all antimicrobials except the aminoglycocides;
   - this effect can be accomplished by ascorbic acid, ammonium chloride, cranberry or grape juice;
- See: Methenamine Hippurate/Hiprex


Management of urinary tract infections in adults.

Urinary tract infection in oliguric patients with chronic renal failure.

A comparison of the urological complications associated with long-term management of quadriplegics with and without chronic indwelling urinary catheters.

Bacteriuria in the catheterized patient. What quantitative level of bacteriuria is relevant?