Uncomplicated Urinary Tract Infection in Women

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Source: Institute for Clinical Systems Improvement (ICSI). Uncomplicated urinary tract infection in women. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2006 Jul. 33 p. Uncomplicated Urinary Tract Infection in Women Adult female presents or calls with one or more of the following symptoms: *dysuria *frequency *urgency. A A = Annotation Complicating factors present? A *UA/hold for UC. *Patient education. A Provider evaluation. A Symptoms of or risk for other GU diseases? A *UA/hold for UC. *Patient education. Provider evaluation. A Patient/provider preference for phone treatment without UA? A *Short course therapy. *Patient education. A Complicating Factors. Provider evaluation indicated, short course therapy with TMP/SMX not appropriate: Symptoms: *Greater than 7 days duration. *Rigors (shaking chills). *Flank pain: mid-back, severe, new occurring with onset of these symptoms. *Temperature greater than 101 degrees F. *UA. *Patient education. History: *Diabetes. *Pregnancy. *Immunosuppressed (e.g., steroids, chemotherapy). *Renal calculi or renal insufficiency. *Known functional or structural urologic abnormalities. Pyuria or dipstick abnormal? A Provider evaluation. A *Urinary tract catheterization (or other urologic procedure or instrumentation) within last 2 weeks. *Discharge from hospital or nursing home within last 2 weeks. *Greater than or equal to 4 UTI's within last 12 months. *Failure of TMP/SMX treatment for UTI within last 4 weeks. *Resident of extended care facility. *Short course therapy. *Phone contact or clinic visit with a medical provider. A Provider evaluation indicated, short course therapy at physician discretion: *Nausea, vomiting, or abdominal pain. *Age less than 18 years or greater than 65 years. *Antibiotic treatment within last 4 weeks. *Pyelonephritis (acute) within last 3 months. Short Course Therapy 1. Trimethoprim-sulfamethoxazole D.S. 1 twice daily x 3 days. 2. Trimethoprim 100 mg 1 twice daily x 3 days (Trimethoprim may have a lower side effect profile than Trimethoprim-sulfamethoxazole). Symptoms of or risk for other GU diseases. Provider visit indicated; short course therapy at physician discretion; perform pelvic exam: Other GU symptoms: Recent onset of or change in vaginal discharge, odor, itching or dyspareunia If allergic to Sulfa or Trimethoprim: 3. Nitrofurantoin (Macrobid) 100 mg twice daily x 7 days. 4. Ciprofloxacin 250 mg BID x 3 days (There is concern about emerging resistance.). Chlamydia risk factors: Contact with a partner infected with an STD or New sexual partner within the last 3 months and no barrier contraception All copyrights are reserved by the Institute for Clinical Systems Improvement, Inc.