Pyuria

Pyuria
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Overview
Definition
Classification
Pyuria Differential Diagnosis
Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

To view a comprehensive algorithm of common findings of urine composition and urine output, click here

Overview

Pyuria refers to urine which contains pus. Defined as the presence of 10 or more neutrophils per high power field of unspun, voided mid-stream urine. It can be a sign of a bacterial urinary tract infection. Pyuria may be present in the septic patient, or in an older patient with pneumonia. Sterile pyuria is urine which contains white blood cells (pus) while appearing sterile by standard culture techniques. Sterile pyuria is listed as a side-effect from some medications such as paracetamol (acetaminophen).

Definition

Pyuria is a condition in which urine contains pus. Definition of pyuria is as follow:

• Presence of 10 or more white cells/mm³ in a urine specimen
• Positive result on Gram’s stain of an unspun urine specimen
• Positive leukocyte esterase on urinary dipstick test

Pyuria might be a sign of a bacterial or non bacterial urinary tract infection.

Classification

Pyuria may be classified based on the presence of detectable infection as shown below:

Classification of pyuria
Group	Cell count	Bacteria	Etiology
Sterile pyuria	↑	-	Might have infectious or non-infectious etiologies.
Bacteriuria	↑	Positive bacterial colony >1000 colony-forming units/ml	Mostly have infectious etiologies.

Treatment

• Sterile pyuria

• . Pathogen-directed antimicrobial therapy

• Renal Tuberculosis

• Preferred regimen: (Isoniazid 300 mg PO qd for 2 months AND Rifampicin 450-600 mg qd for 2 months AND Ethambutol 15-25 mg/kg PO qd for 2 months AND Pyrazinamide 1500 mg for 2 months) THEN (Isoniazid 300 mg PO qd for 4-6 months AND Rifampicin 450-600 mg qd for 4-6 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, Candida albicans: Fluconazole 100 mg PO qd for 2-5 days
• Preferred regimen, non-albicans Candida: Amphotericin B 0.1 mg/kg/day IV for 2-5 days OR Amphotericin B bladder irrigation 5-50 mg/L of sterile water qd for 2-5 days

• Schistosomiasis

• Preferred regimen: Praziquantel 20 mg/kg PO bid for 1–2 days