urinary tract infection
TRANSCRIPT
UTIs are defined by the presence of micro organisms within the urinary tract
Difficult to distinguish between contamination, colonization or infection
150 million people per year become infected
20% of women between ages 20-65 suffer one attack per year
Approximately 50% of women develop a UTI at least once.
1%-6% of general practitioner visits are for UTIs.
CHRONIC General loss of health
anaemia,hypertension. Chronic Pylonephritis-
Chronic hypertension &renal failure.
Pus cells (+) Significant bacteriuria
ACUTE Infection localized to
urethra and bladder. frequency, urgency,
dysuria, pain in perineum. +/- fever, chills,
leucocytosis Pus cells (+++) Urine culture (+)– “significant bactertiuria”
Urethritis- painful urination and burning
Cloudiness in urine
Blood in urine
Micro organism counts:100,000/ml (traditional)1000/ml of one type100/ml of E.coli
Cystitis- inflammation of the bladder, but known to patients as any UTI.
Infection caused by bacterial infection mainly E. coli.
Symptoms include painful, burning, urgent urination and WBC in urine.
Women mainly get this because of the shorter urethra, which puts it closer to the anus where E.coli is found.
Pyelonephritis- Acute infection of the
kidneys caused by progressively untreated cystitis
Symptoms include fever, loin pain, increase in WBC, and bacteraemia
Can compromise kidney function and require IV antibiotics
Chronic pyelonephritis- caused by chronic inflammation of renal and tubular tissue with scarring and shrinkage secondary interstitial fibrosis.
Rectum vaginal intoritus
Bacteria
Urethra
Bladder
95% of UTI are due to gram –ve bacilli. -80% E.coli (commonest) -15% Proteus Klebsiella Pseudomonas 5% of UTI are due to gram +ve cocci Enterococci Staphylococci Streptococci Mixed infections are likely to be present in
chronic cases, in diabetics, obstructive uropathies, indwelling catheters
Bacteriological examination of mid stream urine.
Diabetes mellitus must be ruled out.
Men with UTI often have obstructive lesions or a focus of infection in the prostrate.
BACTERIOSTATIC AGENT
SulfonamidesTetracyclineNitrofurantoin
URINARY ANTISEPTICS
Nalidixic acidMethenamine mandelateNitrofurantoin
BACTERICIDAL AGENTS
CotrimoxazoleAmpicillinExtended spect. Penicillin
AminoglycosidesFluroquinolonesCephalosporins
Effective against E.coli Ineffective in-chronic, complicated
cases or mixed infections Cheap, easily available, and effective
orally. Bacterial resistance major problem. DOC: Sulfisoxazole 2g initially 1g qid
for 7-10 days Prerequisite-Alkaline urine, liberal fluid
intake.
Rapid g.i. absorption, high urinary concentration.
Bacteriostatic against common pathogens. Pseudomonas, proteus resistant. Not recommended for acute UTI. For ‘Chronic suppressive therapy’— 50-100 mg /day for several wks. Mainly useful for resistant infections, mixed
infections, infections associated with obstructive uropathy.
Mandelic acid +methenamine
Formaldehyde (acid PH 5.5)
Active against g-ve pathogens & c.albicans
Not effective in acute ,upper UTI,aginst proteus & pseudomonas
Dose:1 g qid
Used as reserved drug for occasional cases (esp. proteus resistant to other drugs)
Dose: 1gm qid x 7-10 days
Highly potent and cost effective bactericidal combination used aginst E.coli & proteus.
Dose: Acute UTI-2 tab bd x 7-10 days
Chronic UTI-1 tab twice a wk. Contraindicated in pregnancy. Successful in recurrent UTI in men
(prostatic focus) Ineffective in renal insufficiency.
Effective bactericidal to E.coli ,aerobacter. Proteus, pseudomonas resistant. Ineffective against penicillinase producing
staph. aureus. Safe in pregnancy Dose:.0.5 g qid x 7-10 days. Resistant strains of E.coli esp.. hospital
acquired has been found.
CARBENICILLIN:Useful in pseudomonas infection of urinaryInfection when combined with Gentamicin.
PIPERACILLIN:-Broad spectrum activity against g-ve org.(pseudomonas areuginosa).
-Dose:4-8 g iv daily in divided doses.
Status – use should be limited to severe life threatening infections.
Gentamicin is the only aminoglycoside used in UTI.
Effective against E.coli,proteus,pseudo. Disadv.- parental use renal toxicity ototoxicity Reserved for complicated UTI
Ideal agents and drug of choice.
Useful in nosocomial pylonephritis, complicated UTI.
Present status: first line drug for all UTI.
Valuable in infections resistant to other antibiotics (E.coli, Proteus,Pseudomonas)
Doc. –Klebsiella infections. Indicated in septicemic UTI.
1. Acute cases treatment immediate.2. Chronic case treatment after investigations.3. Drug must achieve adequate conc. In tissue
and lumen.4. Drug may be cidal /static –former more
capable.
5. Doses should be adequate for adequate period.
6. PH of urine should be maintained at level that permit optimum antibacterial activity.
7. Urine culture, gram staining to confirm diagnosis, AST to guide therapy.
8. Predisposing factors must be eradicated.
1.Acute complicated cystitis: 3 day regimen
Cotrimoxazole : 2 tab bdAmpicillin : 250-500mg qidCephalexin :500mg qidTrimethoprin :100mg bdNorflox : 400mg bdCiproflox : 250mg bd
7-14 days treatment :Indications:Failure of 3 day regimenSymptomatic menRecurrence both in men & womenPregnant womenChildrenPatients with renal disease
2.Cystitis : Any drug to which org ,is sensitive.( listed above)
3. Chronic persistent infection :Commonly occur with indwelling catheter.Treatment: one of the drug from 7-14 days regimen.
4.Asymptomatic bacteruria : no treatment
5.Post coital cystitis: full coarse + 0.5% cetrimide cream.
6.Acute urethritis: Doxy 100mg bd X 7 days
1.Acute uncomplicated pylonephritis:Drug regimen :Cotrimoxazole /Gentamicin with/ without Ampicillin /Cephalosporins
2.Complicated UTI :Minimal symptoms- Cipro. 500mg bdSevere illness :(Inj. Cefotaxime 2g qid iv & Inj.Genta 5 mg/kg od iv) x7-14 days
3.Chronic Pylonephritis : choice of drug after ASTcause to be searched.