The article in brief
The management of urinary tract infections requires an approach tailored to each situation, with a precise diagnosis and appropriate treatment.
- Diagnosis based on symptoms and urine tests
- Treatment varying according to the type of infection and risk factors
- Prevention essential for recurrent cystitis
- A new approach to simplified screening in pharmacies
Urinary tract infections are a common health problem, particularly in women. As an experienced urologist, I am regularly confronted with this pathology in my practice. Management of a urinary infection requires an approach tailored to each situation. Throughout this text, I will guide you through the various stages of diagnosis and treatment, drawing on my expertise and current recommendations.
Diagnosis and initial assessment of a urinary tract infection
The diagnosis of a urinary tract infection is based on several key elements. The most common symptoms are burning and urgency. These symptoms are often very uncomfortable for patients, as I have seen over the years.
To confirm the diagnosis, we generally use a urine dipstick test. This simple test detects the presence of leucocytes and nitrites in the urine, indicating an infection. In certain cases, particularly if there are risk factors for complications or if the patient is not progressing well, I recommend an ECBU (Urine Cytobacteriological Examination).
Risk factors for complications
It is essential to identify the risk factors for complications, as they influence management. Here are the main ones:
- Pregnancy
- Urinary anomalies
- Severe renal insufficiency
- Immunosuppression
- Age over 75
- Age over 65 with criteria for frailty
The presence of one or more of these factors requires special attention and may modify the therapeutic approach.
Treatment adapted to the type of urinary infection
The choice of treatment depends on the type of urinary tract infection diagnosed. I'm going to present the current recommendations for the different situations I frequently encounter in my practice.
Acute simple cystitis
For simple acute cystitis, with no risk factors for complications, two treatment options are preferred:
- Fosfomycin-tetamol 3g as a single dose
- Pivmecillinam 400 mg twice a day for 3 days
These short treatments are generally well tolerated and effective. I have seen a rapid improvement in symptoms in the majority of my patients using these protocols.
Cystitis at risk of complications
The management of cystitis at risk of complications is more delicate. Here are the recommendations I follow:
| Situation | Recommended treatment | Duration |
|---|---|---|
| Delayed treatment (adapted to antibiogram) |
1. Amoxicillin 1g 3 times/day 2. Pivmecillinam 400 mg 2 times/day 3. Nitrofurantoin 100 mg 3 times/day |
7 days |
| Immediate treatment required |
1. Nitrofurantoin 100 mg 3 times/day 2. Fosfomycin-trometamol 3g at D1, D3 and D5 |
7 days |
The choice between delayed or immediate treatment depends on the severity of the symptoms and the clinical context. In my practice, I carefully assess each case to determine the best approach.
Management of recurrent cystitis
Recurrent cystitis, defined as at least 4 episodes in a 12-month period, is a major concern for many patients. Over the years, I have developed a comprehensive approach to managing these complex cases.
Preventive measures
Before considering medication, I systematically recommend preventive measures:
- Proper hydration
- Regular urination
- Regulation of intestinal transit
These simple habits can considerably reduce the risk of recurrence. I always stress the importance of these dietary hygiene measures to my patients.
Antibiotic prophylaxis
When preventive measures are not enough, particularly in the case of very frequent episodes (≥1 per month), I consider antibiotic prophylaxis. My preferred options are:
- Fosfomycin-tetamol 3g per week
- Trimethoprim 150 mg per day
This approach significantly reduces the frequency of infections, but must be used with care to limit the risk of antibiotic resistance.
Innovations in screening and treatment
Recently, a new approach to simplified screening in pharmacies was introduced for women aged 16 to 65 with no risk factors. This scheme, which I find particularly interesting, provides faster access to diagnosis and treatment.
The urine test is carried out directly by the pharmacist, at a cost of €6, reimbursed at 70%. If the result is positive, the patient is referred to a doctor for treatment. If the result is negative, the diagnosis of urinary infection is ruled out, and a medical consultation is recommended to investigate other possible causes of the symptoms.
This innovation contributes to more effective management of urinary tract infectionsI've found that this system allows for better management of simple cases, leaving me more time for complex cases requiring in-depth urological expertise. In my own practice, I've found that this system makes it easier to manage simple cases, leaving me more time for complex cases requiring in-depth urological expertise.
Ultimately, the management of urinary tract infections requires a personalised approach, taking into account the type of infection, risk factors and the patient's history. The aim is twofold: to ensure effective treatment while limiting the development of antibiotic resistance. As a urologist, I remain vigilant to changes in recommendations and innovations in this field, so as to offer my patients the best possible care.
Sources :
wiki urology
urology department
