Urinary Tract Infection

An estimated 40 percent of women report having had a UTI at some point in their lives, and UTIs are the leading cause of gram-negative bacteremia. I. Acute uncomplicated cystitis in young women

A. Sexually active young women have the highest risk for UTIs. Their propensity to develop UTIs is caused by a short urethra, delays in micturition, sexual activity, and the use of diaphragms and spermicides.

B. Symptoms of cystitis include dysuria, urgency, and frequency without fever or back pain. Lower tract infections are most common in women in their childbearing years. Fever is absent.

C. A microscopic bacterial count of 100 CFU/mL of urine has a high positive predictive value for cystitis in symptomatic women. Ninety percent of uncomplicated cystitis episodes are caused by Escherichia coli, 10 to 20 percent are caused by coagulase-negative Staphylococcus saprophyticus and 5 percent are caused by other Enterobacteriaceae organisms or enterococci. Up to one-third of uropathogens are resistant to ampicillin, but the majority are susceptible to trimethoprim-sulfamethoxazole (85 to 95 percent) and fluoroquinolones (95 percent).

D. Young women with acute uncomplicated cystitis should receive urinalysis (examination of spun urine), and a dipstick test for leukocyte esterase.

E. A positive leukocyte esterase test has a reported of 75 to 90 percent in detecting pyuria associated with a UTI. The dipstick test for nitrite indicates bacteriuria. Enterococci, S. saprophyticus and Acinetobacter species produce false-negative results on nitrite testing.

F. Three-day antibiotic regimens appear to offer the optimal combination of convenience, low cost and efficacy comparable to seven-day or longer regimens.

G. Trimethoprim-sulfamethoxazole (Bactrim, Septra), 1 DS tab bid, remains the antibiotic of choice in the treatment of uncomplicated UTIs in young women.

H. The use of fluoroquinolones as first-line therapy for uncomplicated UTIs is recommended for patients who cannot tolerate sulfonamides or trimethoprim, who have a high frequency of antibiotic resistance because of recent antibiotic treatment, or who reside in an area with significant resistance to trimethoprim-sulfamethoxazole. Treatment should consist of a three-day regimens of one of the following:

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