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Paired kidney Ureters Urinary bladder Urethra

Cystitis

and urethritis, the two forms of lower urinary track infection (UTI), are nearly ten times more common in females than in males. Lower UTI is also a prevalent bacterial disease in children, with girls also most commonly affected.

In

men and in children of either sex, lower UTIs are usually related to anatomic or physiologic abnormalities and therefore require extremely close evaluation. UTIs typically respond readily to treatment, but recurrence and resistant bacterial flare-up during therapy are possible..

Ascending

infection by a single gram negative enteric bacterium ( ESCHERIA COLI, KLEBSIELLA,PROTEUS,ENTERO BACTER,PSEUDONOMAS, OR SERRATIA) Simultaneous infection with multiple pathogens.

Benign

prostatic hyperplasia Bowel incontinence Catheterization Cystoscopy Diabetes History of analgesic or reflux nephropathy

Immobility

or decreased

mobility Incomplete emptying of the bladder (in elderly patients) Indwelling urinary catheter Lack of adequate fluids Pregnancy Prostatitis Urethral strictures

pain or tenderness over the bladder area. Chills Cramps or bladder spasm Dysuria Feeling o f warmth during urination Fever, flank pain Hematuria

Abdominal

Itching Low back pain Malaise Nausea, vomitting Nocturia Urethral discharge in males Urinary frequency and

urgency

Characteristic

signs and symptoms and microscopic urinalysis showing red blood cell and white blood cell counts greater than 10 high power field suggest lower UTI. A clean catch, midstream urine specimen revealing a bacterial count of more than 100,000/ml confirms the diagnosis. Lower counts don't necessarily
rule out infection,

Especially

if the patient is voiding frequently, because bacteria require 30 to 45 minutes to reproduce in urine. Careful midstream, clean catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria. Sensitivity testing determines the appropriate therapeutic antimicrobial agent.

Sensitivity

testing determines the appropriate therapeutic antimicrobial agent. Voiding cystoureterography or excretory urography may disclose congenital anomalies that predispose the patient to recurrent UTIs.

Appropriate

antimicrobials are the treatment of choice for most initial lower UTIs. a 7 to 10 day course of antibiotic therapy is standard, but recent studies suggest that a single dose of an antibiotic or a 3 to 5 day antibiotic regimen may be sufficient to render the urine sterile.

After 3 days of urine antibiotic therapy, urine culture should show no organisms. If the urine isnt sterile after 3 days of antibiotic therapy, bacterial resistance has probably occurred, making the use of different antimicrobial necessary.

Single

dose antibiotic therapy with amoxicillin or cotrimoxazole may be effective in females with an acute, uncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether the infection has been eradicated

Teach

the female patient how to clean the perineum properly and keep the labia separated during voiding to collect a clean-catch, midstream urine specimen. Explain that an uncontaminated midstream specimen is essential for accurate diagnosis.

Watch

for GI disturbances from antimicrobial therapy. Teach the patient how to prevent and treat UTIs. Collect all urine samples for culture sensitivity testing carefully and promptly..

Paracetamol Ampicillin Gentamicin sulfate Bacillus clausil