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Urgent Care Focused Guideline Highlights
The following is a highlight of a guideline from another group reviewed by Urgent Care physicians. Our intent is to assure these highlights represent the actual intent of these articles and how they relates to the practice of urgent care medicine. These highlights are not intended to substitute for independent medical judgement nor are they intended to establish a standard of care. UCCOP recommends at minimum reading those portions of this article that relate to the scope of care you provide.
Diagnosis and Management of Urinary Tract Infection in Non-pregnant Females
Published April 2011
Synopsis by Kim Gibson MD and Phillip Disraeli MD
Guideline synthesis: Diagnosis and management of lower urinary tract infection.
In: National Guideline Clearinghouse (NGC). Rockville (MD): 2008 Jan (revised 2011 Apr).
Full article can be found here.
- Classic signs and symptoms of uncomplicated UTI include: dysuria, frequent and urgent urination, suprapubic pain or tenderness, and possibly hematuria.
- The diagnosis of UTI is based primarily on signs and symptoms and patient history.
- The presence of vaginal symptoms (e.g., vaginitis, urethritis) should prompt alternative diagnoses.
- Empirical antibiotic treatment is recommended for women of reproductive age with symptomatic UTI.
- Women with limited signs and symptoms (no more than two) must have dipstick urine analysis to confirm UTI.
- Urine culture is not indicated in the vast majority of initial UTI cases.
- Urine culture is recommended in recurrent UTI, patients unresponsive to treatment, or patients with complicating factors.
- Three days of antibiotic therapy is the preferred duration for treating uncomplicated UTI
- Three days of TMP/SMX is the preferred therapy, except in areas where E. coli resistance is 15-20%, and in those cases use a fluoroquinolone.
- Fluoroquinolones become first-line treatment in women with diabetes, recent hospitalization, antibiotic use in the last 3-6 months, recent TMP/SMX use.
- When nitrofurantoin is chosen, a seven day course is recommended.
- Fourteen days of therapy is recommended for treatment of acute pyelonephritis.
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