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===Sterile pyuria=== | ===Sterile pyuria=== | ||
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:::* Inflammatory disease such as systemic lupus erythematosus or Kawasaki’s disease | :::* Inflammatory disease such as systemic lupus erythematosus or Kawasaki’s disease | ||
:* Pathogen-directed antimicrobial therapy | :* Pathogen-directed antimicrobial therapy<ref>{{Cite journal| doi = 10.1056/NEJMra1410052| issn = 1533-4406| volume = 372| issue = 11| pages = 1048–1054| last1 = Wise| first1 = Gilbert J.| last2 = Schlegel| first2 = Peter N.| title = Sterile pyuria| journal = The New England Journal of Medicine| date = 2015-03-12| pmid = 25760357}}</ref> | ||
::* '''Tuberculosis''' | |||
:::* Preferred regimen: | :::* Preferred regimen: [[Isoniazid]] {{and}} [[Rifampin]] {{and}} [[Ethambutol]] {{and}} [[Pyrazinamide]] for 3–6 months | ||
::* '''Gonorrhea''' | |||
:::* Preferred regimen: [[Ceftriaxone]] 250 mg IM in a single dose, then ([[Azithromycin]] 1 g PO in a single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days) | |||
::* '''Chlamydia''' | |||
:::* Preferred regimen: [[Azithromycin]] 1 g PO in single dose {{or}} [[Doxycycline]] 100 mg PO bid for 7 days | |||
:::* Alternative regimen: [[Erythromycin|Erythromycin base]] 500 mg PO qid for 7 days | |||
::* '''Mycoplasma and ureaplasma''' | |||
:::* Preferred regimen: [[Azithromycin]] {{or}} [[Levofloxacin]] {{or}} [[Moxifloxacin]] | |||
::* '''Genital herpes''' | |||
:::* Preferred regimen: [[Acyclovir]] 400 mg PO tid for 7–10 days or [[Acyclovir]] 200 mg PO five times a day for 7–10 days {{or}} [[Famciclovir]] 250 mg PO tid for 7–10 days {{or}} [[Valacyclovir]] 1 g PO bid for 7 days | |||
::* '''Trichomoniasis''' | |||
:::* Preferred regimen: [[Metronidazole]] 2 g PO in a single dose) {{or}} [[Tinidazole]] 2 g PO in a single dose | |||
:::: Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient. | |||
::* '''Fungal infections''' | |||
:::* Preferred regimen: [[Fluconazole]] {{or}} [[Posaconazole]] {{or}} [[Echinocandins]] {{or}} [[Amphotericin B]] | |||
::* '''Schistosomiasis''' | |||
:::* Preferred regimen: [[Praziquantel]] 20 mg/kg PO bid for 1–2 days | |||
==References== | ==References== | ||
{ | {{reflist}} | ||
Latest revision as of 03:15, 14 June 2015
Sterile pyuria
- Sterile pyuria
- Definitions
- Pyuria: the presence of 10 or more white cells per cubic millimeter in a urine specimen, 3 or more white cells per high-power field of unspun urine, a positive result on Gram’s stain of an unspun urine specimen, or a urinary dipstick test that is positive for leukocyte esterase[1]
- Sterile pyuria: the persistent finding of white cells in the urine in the absence of bacteria, as determined by means of aerobic laboratory techniques (on a 5% sheep-blood agar plate and MacConkey agar plate)[2]
- Bacteriuria: bacterial colony counts of more than 1000 colony-forming units (CFU) per milliliter in urine[3]
- Causes[4]
- Infectious etiologies
- Gynecologic infection
- Urethritis due to chlamydia, Neisseria gonorrhoeae, mycoplasma, or ureaplasma
- Prostatitis
- Balanitis
- Appendicitis
- Viral infection of the lower genitourinary tract
- Genitourinary tuberculosis
- Fungal infection
- Parasitic disease such as trichomoniasis or schistosomiasis
- Non-infectious etiologies
- Current use of antibiotics
- Recently treated urinary tract infection (within past 2 weeks)
- Presence or recent use of a urinary catheter
- Recent cystoscopy or urologic endoscopy
- Urinary tract stones
- Foreign body such as surgical mesh in the urethra or a retained stent
- Urinary tract neoplasm
- Pelvic irradiation
- Urinary fistula
- Polycystic kidney
- Rejection of a renal transplant
- Renal-vein thrombosis
- Interstitial nephritis or analgesic nephropathy
- Papillary necrosis
- Interstitial cystitis
- Inflammatory disease such as systemic lupus erythematosus or Kawasaki’s disease
- Pathogen-directed antimicrobial therapy[5]
- Tuberculosis
- Preferred regimen: Isoniazid AND Rifampin AND Ethambutol AND Pyrazinamide for 3–6 months
- Gonorrhea
- Preferred regimen: Ceftriaxone 250 mg IM in a single dose, then (Azithromycin 1 g PO in a single dose OR Doxycycline 100 mg PO bid for 7 days)
- Chlamydia
- Preferred regimen: Azithromycin 1 g PO in single dose OR Doxycycline 100 mg PO bid for 7 days
- Alternative regimen: Erythromycin base 500 mg PO qid for 7 days
- Mycoplasma and ureaplasma
- Preferred regimen: Azithromycin OR Levofloxacin OR Moxifloxacin
- Genital herpes
- Preferred regimen: Acyclovir 400 mg PO tid for 7–10 days or Acyclovir 200 mg PO five times a day for 7–10 days OR Famciclovir 250 mg PO tid for 7–10 days OR Valacyclovir 1 g PO bid for 7 days
- Trichomoniasis
- Preferred regimen: Metronidazole 2 g PO in a single dose) OR Tinidazole 2 g PO in a single dose
- Note: Treat patient’s sex partner if trichomoniasis is diagnosed in patient.
- Fungal infections
- Preferred regimen: Fluconazole OR Posaconazole OR Echinocandins OR Amphotericin B
- Schistosomiasis
- Preferred regimen: Praziquantel 20 mg/kg PO bid for 1–2 days
References
- ↑ Horan, Teresa C.; Andrus, Mary; Dudeck, Margaret A. (2008-06). "CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting". American Journal of Infection Control. 36 (5): 309–332. doi:10.1016/j.ajic.2008.03.002. ISSN 1527-3296. PMID 18538699. Check date values in:
|date=(help) - ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.
- ↑ Kwon, Jennie H.; Fausone, Maureen K.; Du, Hongyan; Robicsek, Ari; Peterson, Lance R. (2012-05). "Impact of laboratory-reported urine culture colony counts on the diagnosis and treatment of urinary tract infection for hospitalized patients". American Journal of Clinical Pathology. 137 (5): 778–784. doi:10.1309/AJCP4KVGQZEG1YDM. ISSN 1943-7722. PMID 22523217. Check date values in:
|date=(help) - ↑ Dieter, R. S. (2000). "Sterile pyuria: a differential diagnosis". Comprehensive Therapy. 26 (3): 150–152. ISSN 0098-8243. PMID 10984817.
- ↑ Wise, Gilbert J.; Schlegel, Peter N. (2015-03-12). "Sterile pyuria". The New England Journal of Medicine. 372 (11): 1048–1054. doi:10.1056/NEJMra1410052. ISSN 1533-4406. PMID 25760357.