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APPENDIX B 148 Acute Dysuria in the Adult Female A. A primary goal of this algorithm is to separate women with acute uncomplicated UTI that can be treated with single dose antibiotic therapy from women with complicated UTI that will require further evaluation or longer duration of therapy. Therefore, women who have symptoms longer than 2 or 3 days, women who have fever or flank pain, pregnant women and women with frequent recurrences or other underlying medical problems need to be eliminated from this algorithm. Initial steps in their management are suggested at branch points of this algorithm, but other algorithms will be necessary to more fully address the management of these groups of patients. Stamm, W., Causes of the Acute Urethral Syndrome in Women, NEJM 1980; 303; 409-415. B. Choices for multiple dose Rx include 7-10 day course of: 1. Trimethoprim sulfa DS BID (contraindicated in pregnancy, known G6PD deficiency or allergic Hx). 2. Amoxicillin 250 mg po tid (1st choice in pregnancy). 3. Nitrofurantoin 50 mg QID (alternative for patient with multiple allergies or pregnant patient with Hx Pen allergy). C. Prophylaxis is usually continued for 6 months. Options for prophylaxis include: 1. Trimethoprim sulfa 1/2 regular strength tab, QHS. 2. Nitrofurantoin 50 mg QHS (in pregnant patient or patient with Hx T/X allergy or known G6PD deficiency). Ronald, A. and Harding, G., Urinary Infection Prophylaxis in Women, Annals Int. Med.1981; 94(2) 268-269. D. Options for single dose Rx include: 1. Trimethoprim sulfa DS 2 tabs x 1. 2. Amoxicillin 3 gm po x 1. Kamaroff, A., Acute Dysuria in Women, NEJM 1984; 310; 368-375. E. Patients who have failed single dose Rx should be considered to have upper tract infection and treated per pyelo protocol.
