Treatment Of Urinary Tract Infection
Treatment Of Urinary Tract Infection
The diagnosis of urinary tract infection depends on the characteristics clinical features and demonstration of more than 100,000/ml organisms in a mid-stream specimen of urine, or any organism in urine from a supra pubic aspiration in urinalysis.
Ideally, results of urine culture and sensitivities should be available before treatment, but if the patient is in discomfort treatment may be started while awaiting the result.
Potassium citrate mixture 10 ml three times daily in half glass of water alkalinizes the urine and relieves dysuria. Alternatively, a heating pad or a hot-water bottle may ease the pain.
Since infection is usually due to E. coli, initial use of antibiotics like trimethoprim/sulfamethoxazole 250 mg b.d (twice daily) or amoxicillin 250 mg t.d.s (three times a day) is rational. The antibiotic can be changed if a resistant organism is identified or the response is unsatisfactory. Alternatively, a class of drugs known as quinolones can be used to treat UTI. These include Ciprofloxacin 250-500mg 12 hourly for 1-3 days or Norfloxacin 400 mg 12 hourly for 1-3 days.
Symptomatic relief usually occurs within 48 hours. A 3-day course is adequate and is superior to single dose treatment.
If infection fails to settle on appropriate antibiotics or recurs rapidly after stopping antibiotics, further investigations must be done. Failure to respond to treatment suggests inappropriate antibiotics, failure to complete the full course of antibiotics, resistant organisms, underlying obstruction, calculus (stone), tumor, urinary retention or specific infection like TB.
Re infection with other organisms, or with the same organism after an interval, is not uncommon, particularly in sexually active women. Women with recurrent urinary infections must adopt some simple measures. These measures are mentioned below:
Fluid intake of at least two liters/day
Regular emptying of bladder (3 hour intervals by day and before retiring)
Ensure complete emptying of bladder
Double micturition (urination) if reflux is present. (The patient should be advised, particularly before retiring for the night, to empty the bladder and then attempt to empty the bladder a second time approximately 10-15 minutes later)
Emptying bladder before and after sexual intercourse
Application of 0.5% cetrimide cream to periurethral area before intercourse
But it is recommended that sexual intercourse should be avoided when infected.
During treatment, one must not take anything that irritates bladder like coffee, alcohol and spicy foods. One must also try his/her best to quit smoking, as it is a well-documented fact that smoking is one of the major causes of bladder carcinoma (cancer).
Finally, it is said that regular drinking of cranberry juice may be helpful in preventing the recurrence of UTI in women. In fact, it is the conclusion of a study published in the British Medical Journal (June 29, 2001). Although cranberry juice does not directly kill the bacteria but it is said that it prevents the adhesion of bacteria to the bladder walls.
Since cranberry juice is readily available product, it might be helpful in reducing the need for antibiotics.
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