(References: Obstet Gynecol. 2008;111:785-794).
More than one half of women will have at least 1 urinary tract infection (UTI) during her lifetime, and 3% to 5% of all women will have multiple recurrences. Acute bacterial cystitis usually presents with dysuria, urinary frequency and urgency, sometimes with suprapubic pain or pressure, and rarely with hematuria or fever. Upper UTI or acute pyelonephritis often presents with fever, chills, flank pain, and varying degrees of dysuria, urgency, and frequency.Screening for and treatment of asymptomatic bacteriuria is not recommended in nonpregnant, premenopausal women. Women with uncomplicated acute bacterial cystitis, including women 65 years or older, should receive antibiotics for 3 days. For initial treatment of symptomatic lower UTI with pyuria, bacteriuria, or both, urine culture is not required. For uncomplicated acute bacterial cystitis, recommended treatment regimens are as follows:
- The preferred therapy is Trimethoprim–sulfamethoxazole (1 tablet (160 mg trimethoprim–800 mg sulfamethoxazole) twice daily for 3 days), or Trimethoprim 100 mg twice daily for 3 days. When resistance rates are more than 15% to 20%, antibiotic class should be changed.
- Ciprofloxacin 250 mg twice daily for 3 days, levofloxacin 250 mg once daily for 3 days, norfloxacin 400 mg twice daily for 3 days, or gatifloxacin 200 mg once daily for 3 days.
- Nitrofurantoin macrocrystals 50 to 100 mg 4 times daily for 7 days.
- Nitrofurantoin monohydrate 100 mg twice daily for 7 days.
- Fosfomycin tromethamine 3-g dose (powder) single dose.
For women with frequent recurrences of lower UTI, continuous prophylaxis decreases recurrence risk by 95%. The need for continued prophylaxis can be re-evaluated after 6 to 12 months. For women with frequent recurrences of lower UTI, continuous prophylaxis has been shown to decrease the risk for recurrence by 95%. Suitable prophylactic regimens include once-daily treatment with nitrofurantoin, norfloxacin, ciprofloxacin, trimethoprim, trimethoprim–sulfamethoxazole, or another agent listed in this article.
Women with infections that do not respond to appropriate antimicrobial therapy or in whom the clinical status worsens require further evaluation. Renal ultrasonography is the best noninvasive method to evaluate renal collecting system obstruction.