Pyelonephritis and UTI

Question 1

What are the most common causes of UTIs?

Answer 1

• E. coli
• Proteus
• Klebsiella
• Enterobacter
• Pseudomonas

Question 2

Describe the pathogenesis of most UTIs

Answer 2

• Ascending infection (cystitis before pyelonephritis, usually)
• Haematogenous seeding of kidneys (bacteraemia)
• Urethral obstruction (commonly in men - BPH)

Question 3

What signs/symptoms might you find in someone with a UTI? How might you distinguish cystitis from pyelonephritis?

Answer 3

• Fever (higher in PN)
• Irritative urinary symptoms
• Nausea/vomiting
• Loin pain (PN)
• Suprapubic pain/tenderness (cystitis)

Question 4

What are the empiric antibiotics used in the treatment of mild pyelonephritis?

Answer 4

• Amoxyclav OR cephalexin OR trimethoprim
• AND ciprofloxacin or norfloxacin if Pseudo or resistant bacteria

Question 5

What are the empiric antibiotics used in the treatment of moderate/severe pyelonephritis?

Answer 5

• IV
• Gentamicin OR ceftriaxone OR cefoxatime
• AND ampicillin OR amoxycillin

Question 6

What are the empiric antibiotics used in the treatment of cystitis (or UTI not pyelonephritis)?

Answer 6

• Trimethoprim OR cephalexin OR amoxyclav OR nitrofurantoin
• Norfloxacin can be used if resistant to these