Adult bacterial Urinary Tract Infections: advice

The Afssaps published a document on the diagnosis and the antibiotherapy of the Community bacterial urinary tract infection of the adult, in June 2008. It gives a progress report on the various urinary tract infections and the treatment to be adopted.

The antibiotics should only be used whenever their effectiveness is proven, to avoid side-effects and an increase in the resistance of the bacteria causing these infections.

Simple urinary tract infections

These infections are known as simple because they do not have complication risk factor.

Simple acute cystitis

  • Diagnosis
    • 3 signs :
      • Burns and pains when urinating,
      • Increase in the frequency of urinations,
      • Pressing urinations.

The test by urinary strip can confirm or infirm the diagnosis.
  • Treatment
    • 1st intention: fosfomycin trometamol (single dose)
    • 2nd intention (suspicion of infection with Staphylococcus saprophyticus), according to the antibiotic antecedents of the patient:
      • Nitrofurantoin (5 days),
      • Or Fluoroquinolone (single dose or 3 days).

Recurrent acute cystitis

Cystitis is known as recurrent if the patient has known 4 episodes of simple cystitis in less than one year.
  • Diagnosis
    • The signs are the same ones as for simple cystitis .
    • Complementary examinations:
      • Urinary Strips,
      • ECBU (cyto-bacteriological examination of the urines).
  • Treatment
    • Idem as for simple cystitis.
    • A prophylactic treatment may be considered depending on the case.

Simple acute Pyelonephritis (PNA)

  • Diagnosis
    • Signs are discrete:
      • Fever,
      • Shivers,
      • Pains of the lumbar pit with downward irradiation towards the genital organs,
      • Digestive signs (vomiting, diarrheaâe¦).
    • To confirm the diagnosis, Afssaps recommends to practice "in emergency":
      • Urinary Strips
      • ECBU,
      • Renal and vesical scan.
  • Treatment
    • Different possible treatments (10-14 days; except for Fluoroquinolones, 7 days):
      • Amoxicilline,
      • Clavulanic amoxicilline-acid,
      • Cefixime,
      • Fluoroquinolone (ciprofloxacin, levofloxacine, ofloxacine),
      • Trimethoprim-sulfamethoxazole

Complicated urinary infections

Complicated acute pyelonephritis

  • Diagnosis
    • Idem as for the simple PNA.
    • Complementary examinations:
      • Urinary Strips,
      • ECBU with antibiogramme,
      • Ultrasound scan of the urinary tract or uro-TDM (or uro scan) in the event of contraindication.
  • Treatment
    • Same as for the simple PNA.
    • Hospitalisation if infection worsens (acute sepsis, septic shock,âe¦).

Acute Prostatitis

  • Diagnosis
    • Signs:
      • Urinary function (mictionnelles burns, imperiosity, retention of urineâe¦),
      • Pelvic pains independent from urination,
      • General (fever, shivers,âe¦).
    • In complement:
      • Urinary Strips,
      • ECBU,
      • Ultrasound scan of the urinary tract by sub-pubic way.

L'Afssaps recommends : "A complete physical exam with systematic rectal examination is to be carried out".
  • Treatment
    • Same as for the simple PNA, for 14 days to at least 3 weeks, according to the context.
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