Case Report 21/10/2009 David Tran A&E department FVHospital
Mr MKH, 58 years old, consult in FVH clinic on oct. 21th No past medical history He complains mild fever for 2 days No sore throat, no cough Physical examination without abnormalities What are your investigations ?
Review in A&E 2 days later (23/10) Still headache and mild fever (but 37.6) Abdomen supple no abdominal or back pain He complains decreased mild dysuria Diagnosis: J3 urine infection (pyelonephritis or prostatitis) treated with Bactrim since yesterday. No fever this after noon no signs of severeness (no lombal pain, no chill, no fever) > carry on the treatment and review urologist in 48h (with the result of the ECBU) ; He has to come earlier if high fever or chills.
Review by urologist 2 days later (Oct. 25 th ) No fever Mild dysuria 26/10/2009 : IU avec fievre + dysurie et BM BU : leuco et nitrite (+) Deja eu Bactrim CAT: continuer Bactrim puis RDV ds 2 semaines
What is your decision concerning the treatment? The patient signals allergy to Augmentin® (rash after taking Augmentin® 6 month ago for pharyngitis) He wants to be treated at home Without any injection if possible
Age > 65 years old Pregnancy Sex: male Urine tract abnormality (Stones, tumor, reflux etc) Recent surgical or endoscopic procedure on the urine tract Comorbid diseases (diabetes, renal failure, immunodeficiency) Risk factors for urine infection
Male Urine Infection All urine infection for a male patient is to be considered as a acute prostatitis. Prostatitis has to be considered as complicated urine tract infection. ECBU systematic (70% E. Coli > antibiogramme essential) Hemocultures x 2 if fever or chills Echography systematic (abces, stones?)
Rules of treatment for acute prostatitis Cephalosporine 3 rd generation i.v. or i.m.( Ceftriaxone = OFRAMAX®) Alternative: Fluoroquinolone by mouth (but > 30% resistance of E.Coli but good prostatic diffusion) BACTRIM can only be used to take over from 1 st treatment (after antibiogramme > resistance 20 to 40% but good prostatic diffusion) Avoid AUGMENTIN (30% Coli. Resistant and worst prostatic diffusion) Duration of treatment 2 weeks (simple) to 3 weeks (complicated)