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Urinary tract infection (lower) - women - Management
How should I treat lower UTI in a woman with an indwelling catheter?
- Do not treat asymptomatic bacteriuria.
- Remember that considerable clinical judgement is required to diagnose urinary tract infection (UTI) in women with an indwelling urinary catheter.
- If symptoms are severe (for example, severe nausea and vomiting, confusion, tachypnoea, tachycardia, hypotension, reduced urine output), admit to hospital as intravenous antibiotics may be required.
- Check that the catheter is correctly positioned and not blocked.
- If the catheter has been in place for more than a week, consider changing it before starting antibiotic treatment.
- If there is fever, or loin pain, or both, manage as upper UTI, see the CKS topic on Pyelonephritis - acute.
- Otherwise, treat for lower UTI:
- Relieve symptoms with paracetamol or ibuprofen.
- Send urine for culture and microscopy before starting antibiotic treatment.
- Prescribe an antibiotic for 7 days, following local guidelines when available.
- If symptoms are mild, consider withholding antibiotics until the result of urine culture is available to guide choice of antibiotic.
- If symptoms are moderate or severe, empirically prescribe an antibiotic.
- Follow up after 48 hours (or according to the clinical situation) to check response to treatment and the result of urine culture.
Basis for recommendation
Using clinical judgement to decide when to use antibiotics
- Careful clinical judgement is recommended when deciding to use an antibiotic in a person with an indwelling urinary catheter. This is because all people with a long-term indwelling urinary catheter will have bacteriuria at some stage; there is no good evidence that antibiotics are beneficial; and repeated treatment of asymptomatic bacteriuria increases the risk of colonization by drug-resistant bacteria [SIGN, 2006; European Association of Urology, 2009].
Admitting to hospital
- The recommendation to admit to hospital if systemic symptoms and signs are present is based on expert opinion [SIGN, 2006].
Reviewing catheter care
Using urine culture to guide the choice of antibiotic
- The recommendation to use urine culture to guide treatment and, if practical, to withhold treatment until culture results are available, is based on expert opinion and is intended to reduce the risks of complications and treatment failure, which are generally increased in people with an indwelling urinary catheter [SIGN, 2006].
- The recommendation to change to a more appropriate antibiotic if the antibiotic was started empirically and a resistant organism is isolated on urine culture is based on expert opinion; it is intended to reduce the risks of complications and treatment failure [SIGN, 2006; European Association of Urology, 2009].
Treating for 7 days
- Antibiotic treatment for 7 days is recommended because the evidence is too weak to recommend shorter courses as equally effective.
Relieving symptoms
- CKS found no trials of analgesics for the symptoms of cystitis. The recommendation to use paracetamol or ibuprofen to treat the symptoms of cystitis is based on their use in other painful infections and the experience of experts [SIGN, 2006].
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