When to intubate in GCS?

GCS ≤ 8 requires intubation for airway protection. The patient cannot protect their own airway at this level of consciousness. Motor score is the most prognostically important component.

What is the best initial fluid for sepsis resuscitation?

Lactated Ringer's (LR) is the preferred resuscitation fluid. The SMART trial (2018) showed balanced crystalloids reduced death, new renal failure, and persistent renal dysfunction compared to normal saline.

When to start vasopressors in septic shock?

Start norepinephrine (first-line vasopressor) if MAP remains < 65 mmHg after initial 30 mL/kg crystalloid resuscitation, or earlier if patient is profoundly hypotensive. Do not delay pressors to complete full fluid resuscitation.

Why can serum uric acid be normal during acute gout?

During acute inflammation, IL-6 increases renal urate excretion and redistributes urate from plasma to tissues. Up to 40% of acute gout flares have normal serum uric acid. Joint aspiration with polarized microscopy is needed for definitive diagnosis.

How do you distinguish lupus flare from infection in SLE?

Key clues: CRP is low/normal in flare but elevated in infection. Complement (C3/C4) drops in flare but is normal/elevated in infection. Procalcitonin is elevated in bacterial infection but normal in flare. Anti-dsDNA rises in flare, stable in infection.

What is the difference between DKA and HHS?

DKA features acidosis (pH 600), hyperosmolality (> 320), and minimal ketosis -typically in Type 2 DM. DKA requires insulin drip; HHS requires aggressive fluid resuscitation first.

When to give tPA in acute ischemic stroke?

IV alteplase (tPA) can be given within 4.5 hours of last known well time in eligible patients. CT head must rule out hemorrhage first. For large vessel occlusion, mechanical thrombectomy can be performed up to 24 hours with favorable imaging.

What antibiotics for community-acquired pneumonia?

Inpatient non-ICU: ceftriaxone + azithromycin. ICU: ceftriaxone + azithromycin (add vancomycin if MRSA risk). Outpatient healthy: amoxicillin. Outpatient with comorbidities: augmentin + azithromycin or respiratory fluoroquinolone. Duration: 5 days if clinically stable for 48 hours.

How to interpret iron studies?

Iron deficiency: low ferritin (< 30), high TIBC, low iron, low transferrin saturation (< 20%). Anemia of chronic disease: normal/high ferritin (acute phase reactant), low TIBC, low iron. A ferritin of 50-100 in an inflamed patient may still represent iron deficiency.

What is the correction rate for hyponatremia?

Correct sodium no more than 8 mEq/L in 24 hours to avoid osmotic demyelination syndrome (ODS). For symptomatic severe hyponatremia with seizures, give 3% hypertonic saline 100-150 mL bolus over 10-20 minutes. If overcorrected, use D5W + DDAVP rescue protocol.

When to start antibiotics in meningitis?

Within 30-60 minutes. Do NOT delay antibiotics for LP or CT. Draw blood cultures, start empiric antibiotics (vancomycin + ceftriaxone ± ampicillin if > 50 or immunocompromised), then perform LP when possible. Dexamethasone should be given before or with the first antibiotic dose.

DOACs vs warfarin in antiphospholipid syndrome?

DOACs are contraindicated in APS. The TRAPS trial (2018) showed rivaroxaban was inferior to warfarin with more thrombotic events in triple-positive APS patients. Warfarin with INR target 2-3 is the standard for APS, indefinitely.

How to manage scleroderma renal crisis?

ACE inhibitors (captopril) are life-saving -start immediately and titrate aggressively. Do NOT hold for rising creatinine. Steroids > 15 mg prednisone per day precipitate scleroderma renal crisis. ARBs are NOT a substitute -evidence is only for ACEi.

What are the 4 pillars of heart failure treatment?

Guideline-directed medical therapy (GDMT) for HFrEF: (1) ARNI or ACEi/ARB, (2) beta-blocker (carvedilol, metoprolol succinate, or bisoprolol), (3) MRA (spironolactone or eplerenone), (4) SGLT2 inhibitor (dapagliflozin or empagliflozin). All four should be initiated and titrated to target doses.

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IDCommon

UTI & Pyelonephritis

The most common bacterial infection in adults. The biggest mistake residents make: treating asymptomatic bacteriuria. A positive UA or culture in a patient without urinary symptoms is NOT a UTI -it's colonization. Don't treat the lab.

🔍 Overview

Classification

Type	Definition	Treatment Duration
Uncomplicated cystitis	Lower UTI (dysuria, frequency, urgency) in non-pregnant, premenopausal women with normal urinary tract	3–5 days
Complicated UTI	UTI with: male sex, pregnancy, structural abnormality, catheter, immunosuppression, renal transplant, recent instrumentation	7–14 days
Pyelonephritis	Upper UTI: fever, flank pain, CVA tenderness ± lower urinary symptoms	5–7 days (outpatient FQ) or 10–14 days (if complicated/inpatient)
Catheter-associated UTI (CAUTI)	Catheter in place (or removed within 48h) + symptoms + culture ≥ 10³ CFU/mL. NOT the same as asymptomatic bacteriuria from catheter.	7 days (remove/replace catheter first)

Asymptomatic Bacteriuria -Do NOT Treat

Positive UA/culture WITHOUT urinary symptoms = asymptomatic bacteriuria. Do NOT treat. Treating ASB drives antibiotic resistance, C. diff risk, and adverse drug effects without benefit. IDSA, 2019

Exceptions (treat ASB): pregnancy (risk of pyelonephritis → preterm labor), pre-urologic procedure with mucosal bleeding expected
Do NOT treat ASB in: elderly, catheterized patients, diabetics, spinal cord injury, nursing home residents -even if pyuria is present
Pyuria alone is NOT an indication for treatment -it reflects inflammation, not necessarily infection

💊 Management

Empiric Antibiotics

Diagnosis	First-Line	Alternative	Notes
Uncomplicated cystitis	Nitrofurantoin 100 mg BID × 5 days 1ST LINE	TMP-SMX DS BID × 3 days (if local resistance < 20%). Fosfomycin 3g PO × 1 dose.	Avoid fluoroquinolones for uncomplicated cystitis -FDA warning, collateral damage, save for complicated infections. Nitrofurantoin: avoid if CrCl < 30 (ineffective + toxic). IDSA/ESCMID UTI Guidelines, 2011
Pyelonephritis -outpatient	Ciprofloxacin (Cipro) 500 mg BID × 7 days or levofloxacin (Levaquin) 750 mg daily × 5 days Peterson et al., 2008	TMP-SMX DS BID × 14 days (if susceptible). Ceftriaxone 1g IM × 1 + oral step-down.	FQs are appropriate here (upper tract). Get urine culture to guide de-escalation. Consider admission if: unable to tolerate PO, sepsis, pregnancy, concern for obstruction.
Pyelonephritis -inpatient	Ceftriaxone (Rocephin) 1g IV daily 1ST LINE	Ciprofloxacin 400 mg IV q12h. Piperacillin-tazobactam if MDR risk. Meropenem if ESBL.	Step down to oral once afebrile × 48h and tolerating PO. Total duration depends on oral step-down agent: FQ 5–7 days, TMP-SMX 7–10 days, beta-lactam 10–14 days. CT abdomen if no improvement in 48–72h (abscess? obstruction?).
CAUTI	Based on local antibiogram + culture	Broader coverage initially (ceftriaxone or FQ). Narrow based on susceptibilities.	Remove or replace the catheter first -this alone can resolve the infection. Culture from NEW catheter. Duration 7 days. IDSA CAUTI, 2010 Assess if catheter is still needed -remove ASAP.

ESBL UTI: For uncomplicated ESBL cystitis, nitrofurantoin and fosfomycin retain activity. For ESBL pyelonephritis or complicated UTI, carbapenems (ertapenem, meropenem) are required. Avoid fluoroquinolones even if susceptible in vitro - clinical failure rates are higher with ESBL producers. Doi et al., 2015

Recurrent UTI (>= 3 episodes/year): Evaluate for structural abnormalities (renal ultrasound, post-void residual). Non-antibiotic prevention: vaginal estrogen (postmenopausal), cranberry products, D-mannose. Antibiotic prophylaxis options: post-coital TMP-SMX, continuous low-dose nitrofurantoin. CRAN2013 (Barbosa-Cesnik), 2011

Pregnancy UTI: Screen ALL pregnant women for ASB at 12-16 weeks (one of only two situations where ASB requires treatment). Treat with cephalexin, amoxicillin, or nitrofurantoin (avoid in first trimester and at term). Untreated ASB in pregnancy progresses to pyelonephritis in 20-30% of cases. Smaill & Vazquez (Cochrane), 2019

🔄 Updated Practice: Complicated UTI was traditionally defined by a checklist of host factors (male, catheter, pregnant, etc.). The modern definition is simpler: any UTI that extends beyond the bladder. Additionally, asymptomatic bacteriuria should NOT be treated (except in pregnancy and before urologic procedures) -old practice was to treat all positive urine cultures.

📋 On Rounds

An 85-year-old with dementia has a positive UA (leukocyte esterase, bacteria) but no urinary symptoms. Should you treat?

No. This is asymptomatic bacteriuria (ASB). Up to 50% of elderly nursing home residents and 100% of chronically catheterized patients have bacteriuria without true infection. Treating ASB does not reduce mortality, morbidity, or subsequent symptomatic UTIs -but it does increase antibiotic resistance and C. diff risk. The exception: confusion in the elderly is NOT a urinary symptom. AMS + bacteriuria does not automatically = UTI.

Why should fluoroquinolones be avoided for uncomplicated cystitis?

FQ's (ciprofloxacin, levofloxacin) carry FDA black box warnings for tendon rupture, peripheral neuropathy, aortic dissection, and CNS effects -risks that are disproportionate for a self-limiting infection like uncomplicated cystitis. Nitrofurantoin or TMP-SMX are equally effective with far less toxicity. FQ's should be reserved for complicated UTIs, pyelonephritis when oral is needed, or resistant organisms.

An elderly patient has a positive urine culture but no urinary symptoms. Should you treat?

NO -this is asymptomatic bacteriuria (ASB), and treating it causes harm. ASB is defined as bacteria in urine without urinary symptoms (dysuria, frequency, urgency, suprapubic pain, fever). Do NOT treat ASB -antibiotics don't improve outcomes and promote resistance + C. diff. This is one of the most common antibiotic stewardship violations. Only 2 exceptions where you DO treat ASB: (1) Pregnancy, untreated ASB progresses to pyelonephritis in 20-40% and is linked to preterm delivery and low birth weight; screen and treat all pregnant women. (2) Before urologic procedures with mucosal trauma (TURP, ureteroscopy with stone manipulation), prevents post-procedure bacteremia and sepsis. Pre-procedure antibiotics only, not chronic treatment.

What antibiotics require dose adjustment in renal failure for UTI, and which don't?

Nitrofurantoin: AVOID if CrCl < 30 (doesn't concentrate in urine → ineffective, and accumulates → peripheral neuropathy). TMP-SMX: avoid if CrCl < 15. Watch for hyperkalemia (trimethoprim blocks ENaC). Ciprofloxacin: reduce to 250 mg BID if CrCl < 30. Ceftriaxone: no adjustment needed (biliary excretion). Fosfomycin: single 3g dose, no adjustment needed, but less effective in complicated UTI.

A patient with uncomplicated cystitis has an E. coli culture showing resistance to TMP-SMX but susceptibility to ciprofloxacin. What is the best treatment?

Still nitrofurantoin 100 mg BID x 5 days. Even with TMP-SMX resistance, the answer for uncomplicated cystitis is NOT fluoroquinolones. Nitrofurantoin remains first-line regardless of TMP-SMX susceptibility. FQs carry FDA black box warnings for tendon rupture, neuropathy, and aortic dissection - risks far exceeding the benefit for a self-limited infection. FQs should be reserved for pyelonephritis or complicated UTI.

How do you distinguish UTI from asymptomatic bacteriuria in a catheterized patient?

Catheterized patients almost universally develop bacteriuria by 5-7 days. CAUTI requires new systemic symptoms (fever > 38C, rigors, altered mental status, hemodynamic instability) plus culture >= 10^3 CFU/mL from a freshly placed catheter. Pyuria alone is NOT diagnostic. The IDSA 2010 CAUTI guidelines emphasize that neither pyuria nor bacteriuria alone warrants treatment. IDSA CAUTI Guidelines, 2010

What is the role of urine culture in uncomplicated cystitis?

No urine culture needed for uncomplicated cystitis - treat empirically. Culture is indicated for: complicated UTI, pyelonephritis, recurrent UTI (>= 3/year), treatment failure, suspected resistant organisms, and male UTI. For uncomplicated cystitis, the AUA/CUA/SUFU 2019 guidelines recommend empiric treatment based on local antibiogram. Culturing every UTI drives unnecessary antibiotic changes and delays treatment.

A patient treated for pyelonephritis remains febrile after 72 hours of appropriate antibiotics. What is the next step?

CT abdomen/pelvis with IV contrast to rule out perinephric abscess, renal abscess, or obstruction (obstructive pyelonephritis/pyonephrosis). Perinephric abscess occurs in ~5% of pyelonephritis cases and requires drainage. Obstructive pyonephrosis is a urologic emergency requiring percutaneous nephrostomy or ureteral stent. Also reassess culture susceptibilities and consider resistant organism or alternative diagnosis.

What is the evidence for short-course antibiotic therapy in UTI?

Multiple RCTs support short courses. For cystitis: nitrofurantoin 5 days is non-inferior to 7 days. TMP-SMX 3 days is as effective as longer courses. For pyelonephritis: FQ 5-7 days is non-inferior to 10-14 days. The SCOUT trial showed 7-day courses for pyelonephritis in women were non-inferior to 14 days. Shorter courses reduce C. diff risk, antibiotic resistance, and adverse effects without sacrificing cure rates. Hooton et al., 2012

Case 1: Complicated Pyelonephritis

Presentation: 45F presents with 2 days of fever (39.2°C), right flank pain, nausea, and dysuria. Labs: WBC 16.2, Cr 1.1. UA: pyuria, positive nitrites, many bacteria. Blood cultures drawn × 2.

Initial Management: Started on ceftriaxone 1g IV daily empirically. IV fluids for hydration. Urine and blood cultures pending.

Hospital Course: Blood cultures return positive for E. coli (pan-sensitive). Urine culture confirms same organism. Sensitivities show susceptibility to TMP-SMX (Bactrim). De-escalated to TMP-SMX DS 1 tab PO BID. Afebrile by 48h. Total antibiotic course: 10-14 days (extended due to bacteremia).

Key Teaching Points: Always obtain blood cultures in pyelonephritis (positive in ~25%). Bacteremia extends duration to 10-14 days. If no clinical improvement by 48-72h → CT abdomen/pelvis to rule out perinephric abscess or obstruction. De-escalate based on sensitivities, not empirically.

Case 2: Catheter-Associated UTI (CAUTI)

Presentation: 70M, post-op day 5 from hip replacement, Foley catheter in place × 5 days. New fever (38.6°C), no other localizing symptoms. UA: positive LE, positive nitrites, WBC > 100. Urine culture: Klebsiella pneumoniae > 100K CFU/mL.

Critical Decision: Is this CAUTI or asymptomatic bacteriuria? With a catheter in place, bacteriuria is nearly universal by day 5. Pyuria alone does NOT indicate infection in catheterized patients. However, this patient has new fever without another source → treat as CAUTI.

Management: Foley removed immediately (or replaced if still needed). Started ceftriaxone 1g IV daily. Narrowed to cephalexin (Keflex) 500 mg PO QID based on sensitivities. Total duration: 7 days (shorter course for CAUTI with prompt catheter removal).

Key Teaching Points: Step 1 is always remove or replace the catheter. Do NOT treat asymptomatic bacteriuria in catheterized patients, it does not reduce complications and promotes resistance + C. difficile. Fever is the most reliable sign of true CAUTI. Duration is 7 days (not 10-14) when catheter is removed promptly.

Case 3: ESBL-Producing E. coli UTI

Presentation: 32F with history of 4 UTIs in the past year, now presenting with dysuria and frequency × 2 days. No fever, no flank pain. Prior cultures have shown progressively resistant E. coli. Current urine culture: ESBL-producing E. coli, resistant to TMP-SMX, ciprofloxacin, ampicillin, and ceftriaxone. Susceptible to nitrofurantoin, fosfomycin, and carbapenems.

Management (Uncomplicated Cystitis): Since this is uncomplicated lower tract infection, started nitrofurantoin (Macrobid) 100 mg PO BID × 5 days. Nitrofurantoin retains activity against many ESBL organisms for cystitis because it concentrates in urine. Fosfomycin (Monurol) 3g PO × 1 is an alternative.

If This Were Complicated/Pyelonephritis: Would require ertapenem (Invanz) 1g IV daily or meropenem 1g IV q8h. Carbapenems are the backbone for ESBL complicated infections. Avoid fluoroquinolones even if susceptible in vitro, clinical failure rates are higher with ESBL producers.

Key Teaching Points: ESBL cystitis can often be treated with oral agents (nitrofurantoin, fosfomycin). Save carbapenems for complicated or upper tract ESBL infections. Fluoroquinolones should be avoided for ESBL. Consult ID for recurrent ESBL infections, consider suppressive prophylaxis and evaluation for structural abnormalities.

📣 Sample Presentation

One-Liner

"Ms. Chen is a 28-year-old healthy woman presenting with 3 days of dysuria, frequency, and urgency. No fever, no flank pain. UA: positive LE, positive nitrites, WBC 80. Consistent with uncomplicated cystitis."

Key Points to Cover on Rounds

Uncomplicated cystitis in a healthy, non-pregnant female. Treatment: nitrofurantoin 100 mg BID × 5 days (first-line). Avoided fluoroquinolones (FDA black box, disproportionate risk for self-limiting infection). Urine culture sent but treatment is empiric -will adjust only if resistant. No imaging needed. Plan: symptom relief with phenazopyridine 200 mg TID × 2 days, return if fever/flank pain develop (would indicate pyelonephritis).

Monitoring Parameters -Urinary Tract Infections

Parameter	Frequency	Target / Action
Symptom resolution	48-72h after starting antibiotics	Dysuria, frequency, urgency should improve within 48-72h. If not improving → recheck culture, consider resistant organism, imaging for complication (abscess, obstruction).
Temperature (pyelonephritis)	q4-8h inpatient	Fever should defervesce within 48-72h on appropriate antibiotics. Persistent fever → CT abdomen/pelvis to rule out perinephric abscess or obstruction.
Urine culture results	Check at 48h when available	Narrow antibiotic based on susceptibilities. De-escalate from IV to PO when afebrile 24-48h and tolerating PO.
Creatinine	At baseline; repeat if on nephrotoxic agents or pyelonephritis	Monitor for AKI in pyelonephritis. Adjust antibiotic dosing for renal function (nitrofurantoin ineffective if CrCl < 30).
Blood cultures (pyelonephritis)	At presentation; no routine repeat	Positive in ~20-30% of pyelonephritis. Guides duration (bacteremia may warrant 10-14 day course). Repeat only if persistent bacteremia suspected.

Do NOT repeat UA or urine culture for "test of cure." Bacteriuria can persist after successful treatment and does not require retreatment if the patient is asymptomatic. Repeating cultures leads to unnecessary antibiotic courses and C. diff risk.

🧪 Workup

Diagnostic Workup - UTI & Pyelonephritis

Workup depends on UTI classification. Uncomplicated cystitis: UA dipstick sufficient, no culture needed. Complicated UTI/pyelonephritis: UA + urine culture + blood cultures.

Test	When to Order	Interpretation
UA dipstick	All suspected UTIs	Leukocyte esterase (sensitivity ~75-96%) and nitrites (specificity ~90% but only detects Enterobacteriaceae). Negative nitrites does NOT rule out UTI.
Urine microscopy	Equivocal UA or complicated UTI	WBC > 10/hpf supports UTI. WBC casts suggest pyelonephritis. Bacteria on gram stain corresponds to >= 10^5 CFU/mL.
Urine culture	Complicated UTI, pyelonephritis, recurrent UTI, treatment failure, male UTI	>= 10^5 CFU/mL = significant. >= 10^3 CFU/mL with symptoms can be significant (especially CAUTI). Mixed flora suggests contamination - repeat clean catch.
Blood cultures	Pyelonephritis, sepsis, complicated UTI	Positive in ~20-30% of pyelonephritis. Same organism as urine confirms source. May extend treatment duration to 10-14 days.
CT abdomen/pelvis	No improvement at 48-72h, suspected obstruction or abscess	Rule out perinephric abscess, pyonephrosis, obstructing stone. Contrast required for abscess detection. Stunell et al., 2007
Renal ultrasound	Recurrent UTI, suspected structural abnormality, pregnancy (avoid CT)	Hydronephrosis suggests obstruction. Post-void residual > 200 mL suggests retention. Safe in pregnancy.

💊 Medications

Antibiotic Therapy -Urinary Tract Infections

Uncomplicated cystitis does NOT require urine culture. Treat empirically. Reserve cultures for complicated UTI, pyelonephritis, recurrent infections, or treatment failure. Always check local antibiogram for resistance patterns.

Indication	Drug	Dose	Duration	Key Notes
Uncomplicated Cystitis	Nitrofurantoin (Macrobid) FIRST-LINE	100 mg PO BID	5 days	Avoid if CrCl < 30 (poor urinary concentration). Take with food. Not effective for pyelonephritis (no tissue penetration).
	TMP-SMX DS (Bactrim)	1 DS tab PO BID	3 days	Use only if local E. coli resistance < 20%. Check sulfa allergy. Avoid in 3rd trimester pregnancy.
	Fosfomycin (Monurol)	3g PO × 1 dose	Single dose	Convenient but less effective than multi-day regimens. Good option for MDR organisms (ESBL). Not for complicated UTI.
Pyelonephritis (inpatient)	Ceftriaxone FIRST-LINE	1g IV daily	Step down to PO when afebrile 24-48h; total duration by PO agent: FQ 5-7d, TMP-SMX 7-10d, beta-lactam 10-14d	Broad GNR coverage. Obtain blood and urine cultures before starting. Transition to PO based on susceptibilities.
	Ciprofloxacin	400 mg IV q12h	Step down to PO 500 mg BID; total 5-7 days	Fluoroquinolone -FDA black box warning (tendon, nerve, CNS effects). Use only if no safer alternative. Shorter course (5-7d) if FQ used Sandberg, 2012.
	Piperacillin-tazobactam	3.375g IV q8h (extended infusion)	Narrow when cultures available	Reserve for severely ill or concern for resistant organisms. De-escalate promptly.
Pyelonephritis (outpatient)	Ciprofloxacin	500 mg PO BID	5-7 days	Most effective oral option for pyelo. Check local resistance. Give initial dose of ceftriaxone 1g IV/IM if any concern.
Pyelonephritis (outpatient)	TMP-SMX DS	1 DS tab PO BID	7-14 days	Only if susceptibility confirmed. Give initial parenteral dose (ceftriaxone 1g) for reliable early bactericidal activity.

Asymptomatic bacteriuria: Do NOT treat except in pregnancy or pre-urologic procedure. Positive UA/culture without dysuria, frequency, or urgency = colonization, not infection. Treating ASB drives resistance and causes C. diff.

⚡ Summary

Summary

Uncomplicated Cystitis

Nitrofurantoin 100 BID × 5 days (first-line). TMP-SMX × 3 days (if susceptible). Avoid fluoroquinolones (FDA black box).

Pyelonephritis

Ceftriaxone 1g IV daily (inpatient) or ciprofloxacin 500 BID × 7 days (outpatient, if susceptible). Blood cultures + urine culture.

ASB -Don't Treat

Asymptomatic bacteriuria: treat ONLY in pregnancy or pre-urologic surgery. Not in elderly, catheterized, diabetic, or nursing home patients.

Complicated UTI

Male, pregnant, structural abnormality, catheterized, immunocompromised, recent instrumentation → broader coverage, longer course (10-14 days).

Catheter-Associated

Remove or replace catheter + antibiotics. Duration: 7 days (10-14 if delayed response). Don't treat pyuria alone in catheterized patients.

Recurrent UTI

≥ 3/year or ≥ 2 in 6 months. Options: post-coital prophylaxis, continuous low-dose abx, vaginal estrogen (postmenopausal).

📄 One Pager

UTI & Pyelonephritis - Quick Reference Card

Print this page (Ctrl/Cmd + P) for a condensed reference card.

UTI & PYELONEPHRITIS - AT A GLANCE

🧪 Uncomplicated Cystitis: Nitrofurantoin 100 BID x 5d (first-line). No culture needed. Avoid FQs.
🚨 Pyelonephritis: Ceftriaxone 1g IV (inpatient) or cipro 500 BID x 7d (outpatient). Blood + urine cultures.
⚠️ ASB: Do NOT treat except pregnancy and pre-urologic procedure. Pyuria alone is not UTI.
💊 CAUTI: Remove/replace catheter first. 7 days treatment. Don't treat bacteriuria without symptoms.
📈 Monitor: Symptom resolution at 48-72h. Persistent fever at 72h in pyelo = CT for abscess/obstruction.

📄 One Pager

ID · One Pager

UTI -Cystitis & Pyelonephritis

Cystitis: nitrofurantoin × 5d (avoid FQ). Pyelo: ceftriaxone or cipro. ASB: treat ONLY in pregnancy or pre-urologic surgery. Don't treat pyuria in catheterized patients.

🧪 Uncomplicated Cystitis

Dysuria + frequency + urgency in healthy non-pregnant female. Nitrofurantoin 100 BID × 5d (first-line). TMP-SMX × 3d if susceptible. Avoid fluoroquinolones.

🚨 Pyelonephritis

Fever + flank pain + CVA tenderness. Ceftriaxone 1g IV (inpatient) or cipro 500 BID × 7d (outpatient, if susceptible). Blood cultures + urine culture. Imaging if not improving at 48-72h.

⚠️ Asymptomatic Bacteriuria

Do NOT treat ASB -causes harm (resistance + C. diff). Only 2 exceptions: (1) Pregnancy. (2) Pre-urologic procedures with mucosal bleeding. Not in elderly, catheterized, diabetic, or nursing home.

💊 Key Drugs

Nitrofurantoin100 mg BID × 5d

TMP-SMX DS1 tab BID × 3d

Ceftriaxone1g IV daily

Ciprofloxacin500 mg BID × 7d (pyelo)

⚠️ Pitfalls

FQ for uncomplicated cystitis (disproportionate risk)
Treating ASB in elderly/catheterized patients
Nitrofurantoin if CrCl < 30 (ineffective)
Not culturing urine in pyelonephritis