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

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