Urinary Tract Infection

Prevention and Treatment

Prevention of Urinary Tract Infection

1. Drink plenty (3-4 liters) of fluids daily. Fluids dilute urine and help in flushing bacteria out of the bladder and urinary tract.
2. Urinate every two to three hours. Do not postpone going to the bathroom. Holding urine in the bladder for a long period provides opportunity for bacteria to grow.
3. Consume food containing vitamin C, ascorbic acid or cranberry juice to make urine acidic eventually reducing bacterial growth.
4. Avoid constipation or treat it promptly.
5. Women and girls should wipe from front to back (not back to front) after using the toilet. This habit prevents bacteria in the anal region from spreading to the vagina and urethra.
6. Clean genital and anal areas before and after intercourse. Urinate before and after intercourse and drink a full glass of water soon after intercourse.
7. Women should wear only cotton undergarments, which allow air circulation. Avoid tight-fitting pants and nylon underwear.
8. Recurrent urinary tract infection in women after sexual activity can be effectively prevented by taking a single dose of an appropriate antibiotic after sexual contact.

Treatment of Urinary Tract Infection
General measures

Drink plenty of water. A person who is very ill, dehydrated or unable to take adequate oral fluids due to vomiting, will need hospitalization and administration of IV fluids.

Take medications to reduce fever and pain. Use of heating pad reduces pain. Avoid coffee, alcohol, smoking and spicy foods, all of which irritate the bladder. Follow all preventive measures of urinary tract infection.

Treatment of lower urinary tract infection (cystitis, mild infections)

In a healthy young female, short term antibiotics for three days is usually enough. Some drugs need to be given for seven days to complete a course. Occasionally, a single dose of an antibiotic such as Fosfomycin can be used. Except for a previously healthy adult male who develops a cystitis for the first time, adult males with UTI require 7 to 14 days of antibiotics because of underlying structural abnormalities of the urinary tract that make them prone to infection. Commonly used oral antibiotics are nitrofurantoin, trimethoprim, cephalosporins, or fluoroquinolones. The choice of antibiotic is best determined by the sensitivity and resistance patterns of commonly used drugs in your locality.

Treatment of severe kidney infection (Pyelonephritis)

Patients with moderate-to-severe acute kidney infection, those with severe symptoms or sick patients need hospitalization. Urine and blood cultures are obtained before initiating therapy to identify causative bacteria and proper selection of antibiotics. Patients are treated with intravenous fluids and antibiotics for several days, followed by 10-14 days of oral antibiotics. If response to IV antibiotics is poor (marked by persistent symptoms and fever, worsening kidney function) imaging is indicated. Follow up urine tests are necessary to assess response to therapy.

Treatment of recurrent urinary tract infection

In patients with recurrent UTI, proper identification of the underlying cause is essential. According to the underlying cause, specific medical or surgical treatment is planned. These patients need follow-up, strict adherence to preventive measures and long term preventive antibiotic therapy.

When should a patient with UTI consult a doctor?

All children with UTI should be evaluated by a doctor. Adult patients with UTI should immediately consult a doctor when there is:

• Decrease in urine volume or total absence of urine output.
• Persistent high fever, chills, back pain and cloudy urine or blood in the urine.
• No response to antibiotics after 2 to 3 days of treatment.
• Severe vomiting, severe weakness or fall of blood pressure.
• A single kidney.
• Previous history of stones.