Clinical pathways for the management of urinary tract infection in family and community practice

ABSTRACT

@#<p style="text-align justify;"><strong>BACKGROUND: </strong>Urinary tract infection (UTI) is mainly caused by Escherichia coli and is more common among women than men because of the anatomic difference in the urogenital tract. The management of UTI is not always optimal in terms of diagnostic tests, antibiotic prescription and the length of treatment.</p><p style="text-align justify;"><strong>METHOD: </strong>The PAFP Clinical Pathways Group reviewed published medical literature to identify and summarize clinical information on diagnostics, interventions and clinical indicators or outcomes to develop an evidence-based clinical pathway in family medicine practice. The group developed a time-related representation of recommendations on patient care processes, in terms of history and physical examination, laboratory tests, pharmacologic and non-pharmacologic interventions as well as social and community strategies to treat UTI and prevent complications.</p><p style="text-align justify;"><strong>RECOMMENDATIONS: </strong>Comprehensive history and physical examination focusing on dysuria, increased urinary frequency, and incontinence described as first or recurrent incident. Risk factors include sexual intercourse, use of contraceptive diaphragms in women, mechanical and/or physiologic factors that affect bladder emptying and other complicating condition such as diabetes must be elicited. Physical examination may be normal or show flank or hypogastric tenderness. In terms of diagnostic tests, urine dipstick or microscopic urinalysis may be done. If there are anatomical or other complications ultrasound or imaging studies if structural abnormality, and urine culture and sensitivity may be done.</p><p style="text-align justify;">For treatment, a 3-day course of antibiotics for uncomplicated UTI and 7 days for complicated UTI may be done. Symptomatic treatment with paracetamol/NSAID may also be given. Non-pharmacologic intervention include increase fluid intake, avoidance of delay bladder emptying, discussion and correction of risk factors, and emphasize compliance to medications and laboratory requests. Patients should be aware of the diagnosis and risk factors and they must commit to comply with antibiotic treatment.</p>