0071643192.pdf

RENAL AND GENITOURINARY

EMERGENCIES

SYMPTOMS/EXAM

■ Though most patients have dysuria and urethral discharge, occasional
patients are asymptomatic.

DIAGNOSIS

■ Nucleic acid amplification test of first-voided urine or urethral swab, or
■ Culture of urethral secretions

TREATMENT

■ Regimen must be effective at treating both GC and chlamydia: Ceftriaxone
(IM)orcefixime for GC and doxycycline orazithromycin for chlamydia.
■ Fluoroquinolones are no longer recommended due to a high prevalence
ofN. gonorrheaeresistance.
■ Metronidazole can be considered in patients with persistent symptoms
despite treatment for GC and chlamydia, or if otherwise indicated.

TABLE 18.8. Antibiotic Therapy in UTI

THERAPYDURATION

CONDITION ANTIBIOTIC(INITIALTHERAPY)(TOTAL)

Acute uncomplicated Trimethoprim/sulfamethoxazole or 3 days

cystitis Fluoroquinolone

Acute uncomplicated Trimethoprim/sulfamethoxazole or 7 days

cystitis with comorbid Fluoroquinolone

conditions

Acute uncomplicated Mild to moderately ill:

pyelonephritis ■Oral fluoroquinolone or 7 days

■Trimethoprim/sulfamethoxazole 14 days

Hospitalized:

■IV fluoroquinolone orampicillin/ 14 days

gentamycin

Complicated UTI Mild to moderately ill:

■Oral fluoroquinolone ortrimethoprim/ 14

sulfamethoxazole

Hospitalized:

■IV ampicillin/gentamycin or 14 days

imipenemcilastinorfluoroquinolone

Pregnancy Amoxicillin or trimethoprim/ 7 days

sulfamethoxazole (not in late

third trimester) ornitrofurantoin

Pregnant with Hospitalized:

pyeolonephritis IV gentamycin orceftriaxone 14 days