UTI in afya

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If simple UTI then just treat based on Sx (no dip or MSU, 3/7 Abs)
Sx - frequency, dysuria, ?pain ? unwell (90% with these will have UTI)
Trimethoprim or Nitrofurantoin

If complicated then need MSU (guide treatment if no response) and 7/7 Abs
ie - male, >65, pregnant, significantly unwell (fever, loin pain)
Co-Amoxiclav, Ciprofloxacin
Test of cure

Dipstick - poor accuracy - doesn't help over Sx
use if unclear Sx, if ?STI, or other possible diagnosis (eg stone)
if catheter or >65 dipstick is usually positive so doesn't help

Pregnancy
? Beware Trimethoprim - folate deficiency
Use Cephalexin or Nitrofurantoin
Screening culture at booking - do second culture to confirm as aSx and then Rx (7/7 and test of cure (3-4 days post Rx)
Repeat MSU at every visit as 30% get upper UTI which inc risk

Men - remember orchitis or prostatitis and STI
MSU, Chlamydia, Gonnorhoea ?PR for prostatitis
?refer if poor response or second UTI

Nitrofurantoin - beware skin rash and reduce dose in renal impairment

Recurrent >3 in 12/12
?post coital Abs, regular Abs eg daily trimethoprim

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