OUTPATIENT MANAGEMENT OF URINARY TRACT INFECTIONS IN PRIMARY CARE

Introduction: Urinary tract infections (UTI) are considered one of the most common clinical problems seen in the emergency department. Patients with UTIs usually get acutely symptomatic and seek consultation in an emergency department during off-hours, when they cannot get an appointment with their primary doctor, or if they do not have access to primary physician. Those who present to an ED are usually sicker than those who present to an office-based practice. Infectious disease doctors usually become part of the managing team in management of UTIs only in atypical or complicated cases. Opposite to, emergency doctors whom manage a wider range of medical conditions severity, from uncomplicated cystitis to septic shock. There are many difficulties in managing UTIs in EDs including but not limited to short history, lack of longitudinal follow-up, and lack of culture and susceptibility results. EDs often provide medical care for patients without medical insurance in the US, and most patients have no other access to care or follow-up. The role of the emergency physician is to ascertain complicated versus uncomplicated infection, make disposition decisions concerning hospitalization and level of care, and choose appropriate empiric antimicrobial treatment based on the likely bacterial causes and the ever-changing patterns of antimicrobial resistance. Because UTI are not uncommon, it is highly important to consider the costs in the diagnostic evaluation and management. It could be neither practical nor advisable to send cultures for every case of uncomplicated cystitis. Aim of work: In this review, we will discuss outpatient management of urinary tract infections in primary care Methodology: We did a systematic search for the outpatient management of urinary tract infections in primary care using PubMed search engine (http://www.ncbi.nlm.nih.gov/) and Google Scholar search engine (https://scholar.google.com). All relevant studies were retrieved and discussed. We only included full articles. Conclusions: Emergency doctors see UTIs in a wider spectrum of disease severity and patient populations. Atpical cases presentations are not uncommon, and many patients may lack the typical symptoms of UTI. The diagnosis is especially difficult in the elderly patients, and those patients with indwelling catheters, and in patients with acute urolithiasis. Many patients do not need an extensive diagnostic evaluation and can be safely treated as outpatients with oral antibiotics.