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Urinary Tract Infection Medical Treatment

The usual treatment for both simple and complicated urinary tract infections is antibiotics. The type of antibiotic and duration of treatment depend on the circumstances.

Lower urinary tract infection (cystitis)

In an otherwise healthy young female, a three-day course of antibiotics is usually enough. Some providers prefer a seven-day course of antibiotics. Occasionally, a single dose of an antibiotic is used. Your health-care provider will determine which of these options is best for you.

Adult males with a UTI require seven to 14 days of antibiotics. If the prostate is also infected (prostatitis), four weeks or more of antibiotic treatment may be required.

Adult females with potential for or early involvement of the kidneys, urinary tract abnormalities, or diabetes are usually given a five- to seven-day course of antibiotics.

Children with uncomplicated cystitis are usually given a 10-day course of antibiotics.

To alleviate burning pain during urination, phenazopyridine (Pyridium) or a similar drug, can be used in addition to antibiotics for one to two days.

Upper urinary tract infection (pyelonephritis)

Young, otherwise healthy females with symptoms of pyelonephritis can be treated as outpatients. They may receive IV fluids and antibiotics or an injection of antibiotics in the emergency department, followed by 10-14 days of oral antibiotics. They should follow up with their health-care provider in one to two days to monitor improvement.

If you are very ill, dehydrated, or unable to keep anything in your stomach because of vomiting, an IV will be inserted into your arm. You will be admitted to the hospital and given fluids and antibiotics through the IV until you are well enough to switch to an oral antibiotic.

A complicated infection may require treatment for several weeks.

You may be hospitalized if you have symptoms of pyelonephritis and any of the following:

appear very ill;

are pregnant;

have not gotten better with outpatient antibiotic treatment;

have underlying diseases that compromise the immune system (diabetes is one example) or are taking immunosuppressive medication;

are unable to keep anything in your stomach because of nausea or vomiting;

had previous kidney disease, especially pyelonephritis within the last 30 days;

have a device such as a urinary catheter in place; or

have kidney stones.

Urethritis in men and women can be caused by the same bacteria as sexually transmitted diseases (STDs). Therefore, people with symptoms of STDs (vaginal or penile discharge for example) should be treated with appropriate antibiotics.

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When to Seek Medical Care and Urinary Tract Infection Diagnosis

Seek Medical Care

Any adult or child who develops any of the symptoms of a urinary tract infection needs to be evaluated by a medical professional, preferably within 24 hours. Most medical offices can test urine for infection by using a quick urine "dipstick" test.

If you have symptoms of a lower urinary tract infection, call your health-care provider for an appointment, preferably on the very day that symptoms are recognized.

If you have symptoms of an upper urinary tract infection involving the kidneys, call your health-care provider immediately. Depending on the situation, he or she will recommend either a visit to the office or to a hospital emergency department.

If you have symptoms of a lower urinary tract infection and any of the following applies to you, you may have a urinary tract infection that can potentially be serious. Go to a hospital emergency department right away.

Vomiting and inability to keep down clear fluids or medication

Not better after taking antibiotics for two days

Pregnant

Having diabetes or another disease that affects the immune system (for example, AIDS)

Taking medication that suppresses the immune system such as cancer chemotherapy

Infants, children, and elderly people with any of the signs and symptoms of UTI should go to an emergency department for evaluation.

Fever, lethargy, and poor appetite may indicate a simple lower urinary tract infection in these groups, but they may also be signs of something more serious.

Urinary tract infections have the potential to make these vulnerable people very ill.

Urinary Tract Infection Diagnosis

Diagnosis of a urinary tract infection is based on information you give about your symptoms, medical and surgical history, medications, habits, and lifestyle. A physical examination and lab tests complete the evaluation.

Your doctor may simply perform a urine dipstick test in the office. Only a few minutes are needed to obtain results. Your doctor may also send your urine to the lab for testing. These results take a few days to come back. This tells your doctor the exact bacteria causing your infection and to which antibiotics these bacteria have resistance or sensitivity. The culture is usually sent for special populations, including men, because they are less likely to get UTIs. It is not necessary to send a culture for everyone because the majority of UTIs are caused by the same bacteria.

The single most important lab test is urinalysis. A sample of your urine will be tested for signs of infection, such as the presence of white blood cells and bacteria.

In certain circumstances, your urine also may be "cultured." This means that a small amount of the urine is brushed on a sterile nutrient substance in a plastic plate. The plate is allowed to sit for a few days and then examined to see what kind of bacteria are growing on it. These bacteria are treated with different antibiotics to see which works best against them. This helps determine the best treatment for your specific infection.

Blood tests usually are not required unless a complicated condition, such as pyelonephritis or kidney failure, is suspected.

You may be asked to give a clean-catch, midstream urine specimen. This avoids contamination of the urine with bacteria from your skin. You should be instructed in how to do this.

Midstream means you urinate a little into the toilet before collecting a specimen. The idea is that you don't collect the urine that comes out first, as this urine is often contaminated.

Clean-catch refers to a midstream sample that was collected after cleaning the area of the urethral opening.

Adult women and older girls: Cleanse the area around your urethral opening gently (but completely) using a sterile wipe or soap and water. Catch the urine midstream. For some women, catheterization (inserting a tube into the bladder) may be the only way to obtain a sterile, uncontaminated specimen.

Men and boys: A sterile specimen can usually be obtained with a midstream catch. Uncircumcised males should retract the foreskin and cleanse the area before urinating.

Newborns: Urine may be obtained with a procedure in which a needle is introduced through the lower abdominal wall to draw (aspirate) urine from the bladder.

Infants and children: Either catheterization or the needle aspiration method is used.

If you cannot produce a urine specimen or are unable to follow instructions for a clean-catch specimen, your health-care provider may obtain a urine specimen by catheterizing you.

This means placing a thin tube (catheter) in your urethra to drain urine from your bladder.

The catheter usually is removed after the bladder is emptied.

The catheter may remain in place if you are very ill or if it is necessary to collect all urine or measure urine output.

Depending on their symptoms, young sexually active women could require a pelvic examination because pelvic infections can have similar symptoms as a urinary tract infection.

Men will most likely require a rectal examination so that the prostate can be checked. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection.

In some cases, an imaging test may be indicated to detect any underlying problem in the urinary tract that could cause an infection. This is usually only necessary in repeat infections or special circumstances (unusual bacteria, suspected anatomic abnormalities).

An ultrasound examination can evaluate kidney and bladder problems.

A fluoroscopic study can show any physical problems that predispose children to urinary tract infections.

Intravenous pyelogram (IVP) is a special series of X-rays that uses a contrast dye to highlight abnormalities in the urinary tract.

Cystoscopy involves insertion of a thin, flexible tube with a tiny camera on the end through the urethra into the bladder. This allows detection of abnormalities inside the bladder that might contribute to infections.

Act scan  gives a very detailed three-dimensional picture of the urinary tract.

Imaging tests are most often needed for the following groups:

Children with urinary tract infections, especially boys

Up to 50% of infants and 30% of older children with a urinary tract infection have an anatomic abnormality. The child's pediatrician should investigate this possibility.

Adults with frequent or recurrent urinary tract infections

People who have blood in the urine

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Urinary Tract Infection Symptoms and Signs

Lower urinary tract infection (cystitis): The lining of the urethra and bladder becomes inflamed and irritated.

Dysuria: pain or burning during urination

Frequency: more frequent urination (or waking up at night to urinate, sometimes referred to as nocturia); often with only a small amount of urine

Urgency: the sensation of having to urinate urgently

Hesitancy: the sensation of not being able to urinate easily or completely (or feeling that you have to urinate but only a few drops of urine come out)

Cloudy, bad-smelling, or bloody urine

Lower abdominal pain

Mild fever (less than 101° F), chills, and "just not feeling well" (malaise)

Upper urinary tract infection (pyelonephritis): Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection.

Fairly high fever (higher than 101° F)

Shaking chills

Nausea

Vomiting

Flank pain: pain in your back or side, usually on only one side at about waist level

In newborns, infants, children, and elderly people, the classic symptoms of a urinary tract infection may not be present. Other symptoms may indicate a urinary tract infection.

Newborns: fever or hypothermia (low temperature), poor feeding,jaundice

Infants: vomiting, diarrhea, fever, poor feeding, not thriving

Children: irritability, eating poorly, unexplained fever that doesn't go away, loss of bowel control, loose bowels, change in urination pattern

Elderly people: fever or hypothermia, poor appetite, lethargy, change in mental status

Pregnant women are at increased risk for an UTI. Typically, pregnant women do not have unusual or unique symptoms. If you are pregnant, your urine should be checked during prenatal visits because an unrecognized infection can cause pregnancy complications or miscarriage.

Although most people have symptoms with a urinary tract infection, some do not.

The symptoms of urinary tract infection can resemble those of sexually transmitted diseases.

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urinary tract infection

Urinary Tract Infection Causes

The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.

The culprit in at least 90% of uncomplicated infections is a type of bacteria called Escherichia coli, better know as E. coli. These bacteria normally live in the bowel (colon) and around the anus.

These bacteria can move from the area around the anus to the opening of the urethra. The two most common causes of this are poor hygiene and sexualintercourse.

Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, urinating may not stop their spread.

The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection.

The infection can spread further as the bacteria move up from the bladder via the ureters.

If they reach the kidney, they can cause a kidney infection(pyelonephritis), which can become a very serious condition if not treated promptly.

The following people are at increased risk of urinary tract infection:

People with conditions that block (obstruct) the urinary tract, such askidney stones

People with medical conditions that cause incomplete bladder emptying (for example, spinal cord injury or bladder decompensation aftermenopause)

People with suppressed immune systems: Examples of situations in which the immune system is suppressed are AIDS and diabetes. People who take immunosuppressant medications such as chemotherapy forcancer also are at increased risk.

Women who are sexually active: Sexual intercourse can introduce larger numbers of bacteria into the bladder. Infection is more likely in women who have frequent intercourse. Infection attributed to frequent intercourse is nicknamed "honeymoon cystitis." Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection.

Women who use a diaphragm for birth control

Men with an enlarged prostate: Prostatitis or obstruction of the urethra by an enlarged prostate can lead to incomplete bladder emptying, thus increasing the risk of infection. This is most common in older men.

Males are also less likely to develop UTIs because their urethra (tube from the bladder) is longer. There is a drier environment where a man's urethra meets the outside world, and fluid produced in the prostate can fight bacteria.

Breastfeeding has been found to decrease the risk for urinary tract infections.

The following special groups may be at increased risk of urinary tract infection:

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night sweats

What are the causes of night sweats in women, men, and children?

There are many different causes of night sweats. To determine what is causing night sweats in a particular patient, a doctor must obtain a detailed medical history and order tests to decide if an underlying medical condition is responsible for the night sweats.

Although many people associate menopause with night sweats, this is only one cause of night sweats in women. Many other conditions can cause night sweats in men, women, or children.

What are the symptoms of night sweats?

Depending upon the underlying cause of the night sweats, other symptoms may occur in association with the sweating. For example:

• With certain infections and cancers,fever can develop along with night sweats
• Shaking and chills can sometimes occur
• With cancers such as lymphoma, unexplained weight loss can occur.
• Night sweats due to the menopausal transition are typically accompanied by other symptoms of menopause such asvaginal dryness, daytime hot flashes, and mood changes.
• Night sweats that occur as a side effect of medications can be accompanied by other medication side effects, depending upon the specific drug.
• Conditions that result in increased sweating in general (as opposed to only night sweats) will result in increased sweating at other hours of the day.

Menopause

The hot flashes that accompany the menopausal transition can occur at night and cause sweating. This is a very common cause of night sweats in perimenopausal women. It is important to remember that hot flashes and other symptoms of the perimenopause can precede the actual menopause (the cessation of menstrual periods) by several years.

Idiopathic hyperhidrosis

Idiopathic hyperhidrosis is a condition in which the body chronically produces too much sweat without any identifiable medical cause.

nfections

Classically, tuberculosis is the infection most commonly associated with night sweats. However, bacterial infections, such as the following conditions can also be associated with night sweats:

• endocarditis (inflammation of the heart valves),
• osteomyelitis (inflammation within the bones due to infection),
• abscesses (for example, boils,appendix, tonsils, perianal, peritonsillar,diverticulitis), and
• AIDS virus (HIV) infection.

Cancer

Night sweats are an early symptom of some cancers. The most common type of cancerassociated with night sweats is lymphoma. However, people who have an undiagnosed cancer frequently have other symptoms as well, such as unexplained weight loss andfever

Medication

Taking certain medications can lead to night sweats. In cases without other physical symptoms or signs of tumor or infection, medications are often determined to be the cause of night sweats.

Antidepressant medications are a common type of medication that can lead to night sweats. All types of antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and the newer agents, venlafaxine (Effexor) andbupropion (Wellbutrin) can cause night sweats as a side effect, with a range in incidence from 8% to 22% of persons taking antidepressant drugs. Other psychiatric drugs have also been associated with night sweats.

Medicine taken to lower fever (antipyretics) such as aspirin and acetaminophen can sometimes lead to sweating.

Other types of drugs can cause flushing (redness of the skin, typically over the cheeks and neck), which, as mentioned above, may be confused with night sweats. Some of the many drugs that can cause flushing include:

• niacin (Niacor, Niaspan, Slo-Niacin - taken in the higher doses used for lipid disorders)],
• tamoxifen (Nolvadex)
• hydralazine,
• nitroglycerine, and
• sildenafil (Viagra).

Many other drugs not mentioned above, including cortisone,  prednisone, and prednisolone, may also be associated with flushing or night sweats.

Hypoglycemia

Sometimes low blood glucose(hypoglycemia) levels can cause sweating. People who are taking insulin or oral anti-diabetic medications may experience hypoglycemia at night that is accompanied by sweating.

Hormone disorders

Sweating or flushing can be seen with several hormone disorders, includingpheochromocytoma (a type of adrenal gland tumor that overproduces hormones known as catecholamines), carcinoid syndrome(overproduction of certain hormones by tumors of the lung or gastrointestinal system), and hyperthyroidism (excessive levels of thyroid hormones).

Neurologic conditions

Uncommonly, neurologic conditions may cause increased sweating and possibly lead to night sweats including:

• autonomic dysreflexia,
• post-traumatic syringomyelia,
• stroke, and
• autonomic neuropathy.

Night sweats treatment

The treatment for night sweats depends upon the underlying cause.

In summary, night sweats are usually a harmless annoyance; however, they are sometimes a sign of an underlying medical condition. Persons with unexplained night sweats should seek medical care

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