Question
Ritu, 40-year-old female with complaints of high fever with chills. On asking, she revealed dysuria, urgency etc. A diagnosis of Acute lower urinary tract infection was made. (
- (a) Outline the management. ( 6 mark(s)
- (b) Prescribe suitably for a 24 weeks pregnant Rema, 21year for Acute Lower urinary tract infection. ( 6 mark(s)
- (c) Describe Urinary Antiseptics. ( 2 mark(s)
- (d) Name one urinary analgesic without any antibacterial property. 1 mark(s)
Answer
a) Management of acute lower UTI Empirical antibiotic therapy pending culture — Nitrofurantoin or Fosfomycin first-line for uncomplicated cystitis (favorable resistance profile, short courses), or a fluoroquinolone/cotrimoxazole where local resistance patterns permit. Supportive measures: adequate hydration, urine alkalinization for symptomatic relief, and a urinary analgesic if dysuria is prominent. Therapy is adjusted once culture and sensitivity results are available.
b) Prescription for Rema, 24 weeks pregnant, with acute lower UTI Cephalexin (or Amoxicillin) — a beta-lactam with an established safety profile in pregnancy. Avoid fluoroquinolones (fetal cartilage toxicity) and cotrimoxazole (folate antagonism/neural tube defect risk, and kernicterus risk if used near term) — both are relatively contraindicated in pregnancy.
c) Urinary antiseptics Agents that achieve high concentration in urine but low systemic levels, acting locally within the urinary tract. Examples: Nitrofurantoin, Methenamine (hydrolyzed to formaldehyde in acidic urine, providing non-specific antibacterial action). Used for uncomplicated UTI and prophylaxis of recurrent UTI, not for systemic/upper tract infection given inadequate tissue penetration.
d) Urinary analgesic without antibacterial property Phenazopyridine — a locally acting azo dye that exerts a topical analgesic effect on the urinary tract mucosa, relieving dysuria/urgency without any antibacterial action; used as symptomatic adjunct alongside, never instead of, an appropriate antibiotic.