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Urinary Tract Infection: Diagnosis and Treatment
Diagnosis
- In most cases, urethritis and cystitis can be diagnosed by the
typical symptoms and testing is not necessary.
- In some cases, urinalysis
is useful to confirm the diagnosis. This test is especially useful
to distinguish a UTI from vaginitis (inflammation of the vagina)
in women. Patients with a UTI will have microscopic white blood
cells and nitrites (a chemical produced by the invading bacteria)
in their urine, and possibly also red blood cells.
- In cases of pyelonephritis,
many tests are needed, including urine cultures, blood cultures,
and other blood tests, and possibly other tests, such as X–rays
and CT scans.
- In patients who have repeated UTIs, an in–depth investigation
is needed to determine if an anatomic abnormality is contributing
to the problem. Testing may include X–rays, CT scans, cystoscopy,
or other diagnostic studies.
Treatment
In general, UTIs are treated with antibiotics.
- Simple cases can be given a three to seven day course of oral
antibiotics, which will usually cure the infection.
- In patients
with diabetes or other diseases, and in patients with a history
of multiple UTIs, a longer course of antibiotics may be necessary.
In rare cases, patients may require treatment for six months or
more.
- The most common antibiotics used are a combination of trimethoprim
and sulfamethoxasole (sometimes abbreviated as “TMP/SMX”),
and a group of antibiotics known as fluoroquinolones (such as ciprofloxacin).
- In more severe cases of UTI and in cases of pyelonephritis, hospitalization
is often necessary in order to closely monitor the patient and
to administer intravenous antibiotics.
- Women with recurrent UTIs
who use spermicides and a diaphragm may benefit from alternate
forms of contraception.
In children and elderly individuals, poor
personal hygiene (such as persistently wet diapers or undergarments)
may be a cause of UTIs and should be addressed appropriately.
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