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Infection of the urinary tract often consists for two conditions:

  • Pyelonephritis – This is associated with fever, chills, flank pain, nausea and vomiting, burning micturition, increased urinary frequency and urgency.
  • Cystitis – Burning while voiding, increased urinary frequency and urgency, suprapubic pain, haematuria.
  • Urethritis – Painful micturition, irritation around the urethra, blood in urine.

Medications:

For pyelonephritis:
  • Tab. Amoxyclav 1000 (Amoxicillin 875 mg, Clavulanic acid 125 mg) – one tablet twice a day for 10 days (12.5 mg/kg twice a day for low body weight).
  • For children – Dry syrup Acuclav (Amoxicillin 200 mg, Clavulanic acid 28.5 mg) 12.5 mg/kg/dose twice a day for 10 days.

If no improvement in 3 days change to

  • Adults – Tab. Zofix CV (Cefixime 200 mg, Clavulanic acid 125 mg) one tablet twice a day for 14 days (4 mg/kg twice a day for low body weight).
  • For children – Dry syrup Elfi CV 100 mg/62.5 mg (Cefixime 100 mg, Clavulanic acid 62.5 mg) – 4 mg/kg twice a day for 14 days.

For pregnant patients

  • Tab. Odoxil 500 (Cefadroxil 500 mg) – one tablet twice a day for 10 – 14 days OR
  • Tab. Cefakind-250 (Cefuroxime 250 mg) – one tablet orally twice a day for 10 – 14 days
For cystitis:     
  • Tab. Uribid (Nitrofurantoin modified release 100 mg) – one tablet twice a day for 5 – 7 days (contraindicated in pregnancy).
  • For children – Syrup Urifast (Nitrofurantoin 25 mg/5ml) – 7 mg/kg/day in 4 divided doses for 7 days (maximum dose – 400 mg/day).

If no clinical improvement after 3 days change to

  • Tab. Amoxyclav 1000 (Amoxicillin 875 mg. Clavulanic acid 125 mg) – one tablet twice a day for 7 days (12.5 mg/kg twice a day for low body weight).
  • For children – Dry syrup Acuclav (Amoxicillin 200 mg, Clavulanic acid 28.5 mg) 12.5 mg/kg/dose twice a day for 7 days.

If no improvement in 3 days change to

  • Adults – Tab. Zofix CV (Cefixime 200 mg, Clavulanic acid 125 mg) one tablet twice a day for 14 days (4 mg/kg twice a day for low body weight).
  • For children – Dry syrup Elfi CV 100 mg/62.5 mg (Cefixime 100 mg, Clavulanic acid 62.5 mg) – 4 mg/kg twice a day for 14 days.

If no improvement in 3 days change to

  • Granules Fosforal (Fosfomycin 3 gm) – once as a single dose.
For urethritis
  • Tab. Azee 1000 (Azithromycin 1000 mg) – one tablet as a single dose.
  • Tab. Zifi CV (Cefixime 200 mg, Clavulanic acid 125 mg) – one tablet twice a day for 5 days.
  • Tab. Flagyl 400 (Metronidazole 400 mg) – one tablet twice a day for 7 days.

Supportive treatment:

  • Syrup Cital (Disodium Hydrogen Citrate 1.37 gm/5ml) 15 – 20 mls 2 – 3 per day for symptomatic improvement.
  • For females – V Wash Plus (Lactic acid-based soap solution) regularly for perineal and vaginal cleaning.
  • Cap. Prowel (Prebiotic and probiotic) one capsule twice a day for gut protection whilst on antibiotics.

General advice:

  • Drink up to 2.5 L of water per day.
  • Advice foods with alkaline characteristics (most vegetables and fresh fruits).

Investigations:

  • Urine dipstick test – for nitrites, sugars and proteins.
  • Midstream urine microscopy – for routine microscopy
  • Urine culture and antibiotic sensitivity.
  • Renal function test including eGFR (estimated glomerular filtration rate) – Reduced renal function and eGFR will need adjustments with antibiotic regimen.
  • Ultrasound Kidney Ureter Bladder (KUB) – To rule out structural pathology including stones and strictures.
  • Repeat urine culture after one month – if patient fails to respond.

Referral:

Consider referral to nephrologist if patient fails to respond, has deranged renal function or any other complications. Refer to urologist in case of structural pathology such as stones.