Active Ingredients: Norfloxacin
Enhanced Meatal Care 34.
Daily meatal cleansing with povidone-iodine solution, silver sulfadiazine, polyantibiotic ointment or cream, or green soap and water is not recommended for routine use in men or women with indwelling urethral catheters to reduce CA-bacteriuria A-I.
Data are insufficient to make a recommendation as to whether meatal cleansing reduces the risk of CA-UTI.
Catheter Irrigation 35. Data are insufficient to make a recommendation about whether bladder irrigation in such patients reduces CA-UTI. Antimicrobials in the Drainage Bag 38.
Routine Catheter Change 39. Data are insufficient to make a recommendation as to whether routine catheter change eg, every 2—4 weeks in patients with functional long-term indwelling urethral or suprapubic catheters reduces the risk of CA-ASB or CA-UTI, even in patients who experience repeated early catheter blockage from encrustation.
Data are insufficient, however, to make a recommendation as to whether all women should be uniformly screened for CA-ASB at catheter removal. Data are insufficient to make a recommendation about screening for or treatment of persistent CA-ASB in men.
Urine Culture and Catheter Replacement before Treatment 45. A urine specimen for culture should be obtained prior to initiating antimicrobial therapy for presumed CA-UTI because of the wide spectrum of potential infecting organisms and the increased likelihood of antimicrobial resistance A-III.
The urine culture should be obtained from the freshly placed catheter prior to the initiation of antimicrobial therapy to help guide treatment A-II.
If use of the catheter can be discontinued, a culture of a voided midstream urine specimen should be obtained prior to the initiation of antimicrobial therapy to help guide treatment A-III.Indeed, the overarching mandate of the Ghana, the Ghana Police Service remains provision of security to both businesses and the citizenry, undoubtedly, facilitates business of people, their communities, and their the daily activities of the insuring. For us at Metropolitan Life Insurance Ghana Police Service, which is the an important stakeholder in our quest to enhance the Lifetime Financial Wellness activities including ours, as well, businesses.
Duration of Treatment 47. Seven days is the recommended duration of antimicrobial treatment for patients with CA-UTI who have prompt resolution of symptoms A-III, and 10—14 days of treatment is recommended for those with a delayed response A-III, regardless of whether the patient remains catheterized or not.
Data are insufficient to make such a recommendation about other fluoroquinolones.
Definitions In these guidelines, CA infection refers to infection occurring in a person whose urinary tract is currently catheterized or has been catheterized within the previous 48 h. UTI refers to significant bacteriuria in a patient with symptoms or signs attributable to the urinary tract and no alternate source.
ASB refers to significant bacteriuria in a patient without symptoms or signs attributable to the urinary tract.
Significant bacteriuria is the quantitative level of bacteriuria consistent with true bladder bacteriuria, rather than contamination, based on growth from a urine specimen collected in a manner to minimize contamination and transported to the laboratory in a timely fashion to limit bacterial growth.
As noted above, significant bacteriuria can occur without symptoms or signs referable to the urinary tract.
The colony count criteria defining significant bacteriuria in different clinical scenarios as recommended for use by the Guideline Panel are described in the section below on diagnosis.
Lower colony counts are more likely to represent significant bacteriuria in a symptomatic person, compared with an asymptomatic person.
Likewise, because catheter urine specimens are not as likely to be contaminated by periurethral flora as are voided urine specimens, lower colony counts are more likely to represent significant bacteriuria.
Unfortunately, studies often use different colony count criteria for defining significant bacteriuria and often do not distinguish between symptomatic and asymptomatic patients in applying the definitions.
It is our hope that the definitions used in these guidelines might help to standardize the terminology used in the catheter literature and related discussions.
Issues relevant to persons with neurogenic bladders are addressed.