Urinary Tract Infection [2011 update]

Description: Urinary tract infection (UTI) has a high incidence in adult women. It is often not managed cost effectively, with laboratory tests performed that do not affect the management or outcome of treatment. This self-study activity provides practical guidance to primary care clinicians regarding the diagnosis and treatment of UTI and how to implement a cost-effective management strategy for uncomplicated UTI in women.

Key aspects of care include:

• Pretreatment cultures are rarely necessary for uncomplicated UTI.
• Consider telephone management for uncomplicated UTI in women with previous UTI.
• Despite increasing resistance patterns to trimethoprim / sulfa and ciprofloxicin, clinical response remains robust.
• TMP/SMX or Macorbid are the recommended drugs of first choice in uncomplicated UTI in women. Three days of treatment with Bactrim or five days of treatment with Macrobid is usually sufficient for uncomplicated UTI. Second line therapy alternatives include three days of Cipro or seven days of Amoxacillin.
• Follow up cultures or urinalysis are not usually necessary.

This 2011 update of the guideline also addresses the following points:

• Escherichia coli resistance rates have continued to increase. UMHS rates of resistance to trimethoprim / sulfa = 28% and Ciprofloxicin=27%. Nitrofurantoin resistance is <5%, Amoxicillin >25%.
• Clinical response rates continue at the 80-90% range despite the increasing bacteriologic resistance rates.
• First line therapy recommendations include both trimethoprim / sulfa and Macrobid.
• Recommending alternative forms of contraception is not necessary when prescribing antibiotics for UTI in women using oral contraceptives (OCPs).
• Some studies have shown that cranberry juice or cranberry tablets can significantly reduce the annual incidence of UTIs in sexually active women with a history of recurrent UTIs.