Nhiễm trùng đường tiểu TRONG phụ nữ nhiễm trùng đường tiết niệu ở phụ nữ: Chẩn đoán và quản lý mã nguồn: Đại học Michigan Hệ thống y tế năm 2005 1Adult nữ với UTI SX gọi văn phòng Có HX trước của nhiễm trùng đường tiểu không biến chứng? | 172 DISEASE MANAGEMENT URINARY TRACT INFECTIONS IN WOMEN UTI IN WOMEN DIAGNOSIS AND MANAGEMENT Source University of Michigan Health System 2005 Source Adapted from University of Michigan Health System Urinary Tract Infection guideline June 1999 revised May 2005 NEJM 2003 349 259-266 DISEASE MANAGEMENT URINARY TRACT INFECTIONS IN WOMEN 173 UTI IN WOMEN ALGORITHM NOTES AND TABLES LABORATORY CHARGES AND RELATIVE COSTS Test Relative Cost Urinalysis dipstick Urinalysis complete microscopic Urine culture COMPLICATING FACTORS Catheter Diabetes mellitus Immunosuppression Nephrolithiasis present Pregnancy Pyelonephritis symptoms fever nausea back pain Recent hospitalization or nursing home residence Recurrent UTIs 3 year Symptoms for 7 days Urologic structural functional abnormality TREATMENT REGIMENS AND RELATIVE COSTS Treatment Regimen Relative Cost First Line generic Trimethoprim Sulfa DS BID X 3 days Second Line in preferred order Ciprofloxacin 250 mg BID X 3 days Levofloxacin 250 mg QID X 3 days Amoxicillin 500 mg TID X 7 days Nitrofurantoin 100 mg QID X 7 days Macrobid 100 mg BID X 7 days 1. The majority of UTIs occur in sexually active women. Risk increases by 3-5 times when diaphragms are used for contraception. Risk also increases slightly with not voiding after sexual intercourse and use of spermicides. Dysuria with either urgency or frequency in the absence of vaginal symptoms yields a prior probability of UTI of 70 -80 . Generally UTI symptoms are of abrupt onset 3 days . 2. Guideline implementation decreases the proportion of patients with presumed cystitis who received urinalysis urine culture or an initial office visit and increases the proportion of women who receive a guideline-recommended antibiotic. Adverse outcomes return office visit sexually transmitted disease pyelonephritis within 60 days of initial diagnosis did not increase as a result of guideline implementation. Saint S et al. Am J Med 1999 106 636-641 3. Dipstick analysis for leukocyte esterase
