Lower Urinary Tract Infection
The two forms of lower urinary tract infection (UTI) are cystitis (infection of the bladder) and urethritis (infection of the urethra). They're nearly 10 times more common in females than in males (except in elderly males) and affect 10% to 20% of all females at least once. UTI is prevalent in girls.
In adult males and in children, lower UTls typically are associated with anatomic or physiologic abnormalities and therefore need close evaluation. Most UTls respond readily to treatment, but recurrence and resistant bacterial flare-up during therapy are possible.
The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.
Signs and Symptoms.
The symptoms of a UTI include:
Young children with UTIs may only have a fever, or even no symptoms at all.
Several tests are used to diagnose lower UTI. For example, microscopic urinalysis showing red blood cell and white blood cell counts greater than 10 per highpower field suggests lower UTI.
Clean-catch urinalysis revealing a bacterial count of more than 100,000/ml confirms UTI. Lower counts don't necessarily rule out infection, especially if the patient is urinating frequently, because bacteria require 30 to 45 minutes to reproduce in urine. Clean-catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria.
Sensitivity testing is used to determine the appropriate antimicrobial drug. If the patient history and physical examination warrant, a blood test or a stained smear of urethral discharge can be used to rule out sexually transmitted disease.
Voiding cystourethrography or excretory urography may disclose congenital anomalies that predispose the patient to recurrent UTI.
Appropriate antimicrobials are the treatment of choice for most initial lower UTls. A 7- to 10-day course of antibiotics is standard, but studies suggest that a single dose or a 3- to 5-day regimen may be sufficient to render the urine sterile. (Elderly patients may still need 7 to 10 a days of antibiotics to fully benefit from treatment.) If a culture shows that urine isn't sterile after 3 days of antibiotic therapy, bacterial resistance probably has occurred, and a different antimicrobial is prescribed.
A single dose of amoxicillin or cotrimoxazole may be effective for females with acute, uncomplicated
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