prostatitis can cause hydronephrosis; urolithiases,

MED OSCE UTI which contribute to obstruction, can also be

identified.

N.B. Unfortunately, details of the case were unrecalled, but what can be THERAPEUTICS
distinctly recalled is that the patient was a male in his 50s who 1. Uncomplicated Cystitis
presented with fever and chills; thus, other systemic diseases with • TMP-SMX 160mg/800mg tablet bid for 3 days
fever and chills must be taken into consideration prior to focusing on • Ciprofloxacin 250 to 500 mg tablet bid for 3 days
UTI.
2. Pyelonephritis
DIFFERENTIAL DIAGNOSES • Outpatient setting: Ciprofloxacin 500 mg tablet bid for 7
1. Cystitis days
• Predominantly irritative symptoms: FUND • Parenteral therapy: ampicillin-sulbactam: 375-750 mg
(frequency, urgency, nocturia and dysuria) bid for 5 to 14 days
• Hesitancy, suprapubic discomfort and gross hematuria • Once patient has responded clinically, oral
are often noted as well. therapy should be substituted for parenteral
• Fever also is an indication of invasive infection of either therapy.
the kidney or the prostate.
3. Prostatitis
2. Pyelonephritis • Ciprofloxacin 500 to 750 mg bid
• Mild: low-grade fever +/- CVA tenderness o Acute: 2 to 4 weeks
• Severe: high-grade fever, rigors, nausea, vomiting o Chronic: 4 to 6 weeks
and flank and/or loin pain
• Fever is the main feature distinguishing cystitis from 4. Complicated UTI
pyelonephritis • Guided by urine culture and sensitivity
• Bacteremia develops in 20 to 30% of cases of • Antibiotics must be given intravenously, thus the
pyelonephritis. patient must also be admitted (refer to parenteral
therapy for pyelonephritis)
3. Prostatitis
• Acute bacterial prostatitis presents as dysuria, 5. UTI in Pregnant Women
frequency, and pain in the prostatic pelvic or perineal • Nitrofurantoin 100 mg qid for 10 days
area. • Cephalexin 500 mg bid for 7 to 14 days
• Fever and chills are usually present, and obstructive
symptoms are usually present as well: double voiding,
straining to void, hesitancy, intermittency and post-void
dribbling

4. Complicated UTI
• Symptomatic episode of cystitis or pyelonephritis in a
man or woman with an anatomic predisposition to
infection, with a foreign body in the urinary tract, or with
factors predisposing to a delayed response to therapy
• The patient was diagnosed of complicated UTI
because he had cystitis, pyelonephritis AND
prostatitis.

DIAGNOSTICS
1. Urine Dipstick
• Nitrite and/or leukocyte esterase positivity can be
supportive of urinary tract infection

2. Urinalysis
• Predominantly pyuria
o Females: >5 to 8/hpf
o Males: >0 to 1/hpf
• (+) WBC cast

3. Urine Culture
• GOLD STANDARD
• Downside: culture results do not become available until
24h after the patient’s presentation.

4. CBC
• Do determine for the probable presence of systemic
disease, as indicated by leukocytosis and
neutrophilia

5. KUB UTS
• To determine the gravity/seriousness of the disease i.e.
long-standing prostatic enlargement secondary to

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