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    Urinary Tract Infection

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    Bishal Chauhan
    This document discusses urinary tract infections (UTIs), including their causes, types, diagnosis, and treatment. UTIs are commonly caused by E. coli bacteria entering the urinary tract. The main types are cystitis (bladder infection), urethritis (urethra infection), and pyelonephritis (kidney infection). Diagnosis involves clinical presentation, urine culture, and imaging tests. Treatment involves antibiotics like quinolones, sulfonamides, aminopenicillins, and cephalosporins. Urinary antiseptics like nitrofurantoin and methanamine mandelate can also be used. Proper fluid intake and bladder emptying are important for preventing recurrent UTIs.

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    Urinary Tract Infection

    Uploaded by

    Bishal Chauhan
    12 views23 pages
    This document discusses urinary tract infections (UTIs), including their causes, types, diagnosis, and treatment. UTIs are commonly caused by E. coli bacteria entering the urinary tract. The main types are cystitis (bladder infection), urethritis (urethra infection), and pyelonephritis (kidney infection). Diagnosis involves clinical presentation, urine culture, and imaging tests. Treatment involves antibiotics like quinolones, sulfonamides, aminopenicillins, and cephalosporins. Urinary antiseptics like nitrofurantoin and methanamine mandelate can also be used. Proper fluid intake and bladder emptying are important for preventing recurrent UTIs.

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    This document discusses urinary tract infections (UTIs), including their causes, types, diagnosis, and treatment. UTIs are commonly caused by E. coli bacteria entering the urinary tract. The main types are cystitis (bladder infection), urethritis (urethra infection), and pyelonephritis (kidney infection). Diagnosis involves clinical presentation, urine culture, and imaging tests. Treatment involves antibiotics like quinolones, sulfonamides, aminopenicillins, and cephalosporins. Urinary antiseptics like nitrofurantoin and methanamine mandelate can also be used. Proper fluid intake and bladder emptying are important for preventing recurrent UTIs.

    Copyright:

    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    12 views23 pages

    Urinary Tract Infection

    Uploaded by

    Bishal Chauhan
    This document discusses urinary tract infections (UTIs), including their causes, types, diagnosis, and treatment. UTIs are commonly caused by E. coli bacteria entering the urinary tract. The main types are cystitis (bladder infection), urethritis (urethra infection), and pyelonephritis (kidney infection). Diagnosis involves clinical presentation, urine culture, and imaging tests. Treatment involves antibiotics like quinolones, sulfonamides, aminopenicillins, and cephalosporins. Urinary antiseptics like nitrofurantoin and methanamine mandelate can also be used. Proper fluid intake and bladder emptying are important for preventing recurrent UTIs.

    Copyright:

    © All Rights Reserved
    Download as PPSX, PDF, TXT or read online from Scribd
    Download as ppsx, pdf, or txt
    of 23

    Drugs for:

    Urinary tract Infection

    Dr. Ashish Bhattarai


    lecturer
    MD pharmacology
    What is UTI?
    • > 100000 organisms / ml in MID STREAM sample of urine

    Clinical presentation:
    • Asymptomatic bacteriuria
    • Symptomatic acute urethritis and cystitis
    • Acute prostatitis
    • Acute pyelonephritis
    • Septicemia (usually by Gm -ve)
    Clinical feature
    • Painful Micturition and dysuria,
    • scalding pain in urethra during micturition;
    • urine unpleasant odor and appear cloudy;
    • gross hematuria
    Whom?
    • Men < 1 year and > 60 years

    • Women : common 3% at age of 20


    • Short urethra
    • Absence of bactericidal prostatic
    secretions

    Residual urine after voiding increases


    bacterial production
    Injury to the mucosa
    Presence of obstruction , foreign body
    Diagnosis
    • Clinical presentation
    • Significant growth in MSU
    • Pyuria (presence of neutrophils)
    • X Ray, Ultrasonography
    • Urethritis : infection of anterior urethral tract: dysuria , urgency ,
    frequency of urination

    • Cystitis : dysuria , frequency and urgency , pyuria and hematuria;


    supra pubic pain: and often tenderness; After bladder has been
    emptied there may be intense desire to pass more urine due to spasm
    of inflamed bladder wall

    • Acute pyelonephritis: infection of one or both kidney; some time


    lower tract also; pyuria , fever, painful micturition

    • Chronic pyelonephritis : particular type of pathology to the kidney


    may or may not be associated with infection
    Uncomplicated : UTI without underlying renal or neurological disease

    Complicated: UTI with underlying structural, medical or neurological disease

    Recurrent : > symptomatic UTIs within 12 months following clinical therapy


    • Complicated
    • Abnormal urinary tract ; obstruction, calculi, vesico uteric reflux, neurological
    abnormality, chronic prostatitis, cystic kidney, analgesic nephropathy, renal
    scarring

    • Uncomplicated
    • Normal renal function
    • No associated disorders
    • Anatomically and physiologically normal urinary tract
    UTI

    UPPER LOWER

    Acute pyelonephritis
    Cystitis
    Chronic pyelonephritis
    Prostatitis
    Interstitial pyelonephritis
    urethritis
    Renal abscess/Peri-renal abscess
    Cause
    • E.coli 75% from fecal reservoir
    • Other organisms: proteus, Pseudomonas , streptococci or staph.
    Epidermidis

    • In hospital: Klebsiella or streptococci

    • S. saprophyticus : restricted to infections in young sexually active women


    Virus: rubella mumps, HIV
    Fungi: candida , Histoplasma
    Protozoa: T. vaginalis, S. haematobium
    Management
    • Prophylactic measures in Prophylactic measures:
    case of recurrent infection • Fluid intake
    • Fluid intake at least 2lt/ day • Regular emptying of the
    • Drug therapy bladder
    • Complete emptying
    • Double micturition if reflux
    present
    • Emptying bladder before
    and after intercourse
    Drugs groups effective for the treatment
    • Quinolones
    • Highly susceptible against E. Coli, Proteus, Salmonella typhi
    • High cure rates, even in complicated cases

    • Sulfonamides: attains bactericidal concentration in urine


    • Cotrimoxazole: Courses of 3–10 days for lower and upper urinary tract
    infections.
    • Cotrimoxazole is specially valuable for chronic or recurrent cases or in prostatitis,
    because trimethoprim is concentrated in prostate.
    Drugs groups effective for the treatment
    • Aminopenicillins
    • Due to increased resistance fluroquinolones and Co-trimoxazole more
    preferred for empirical therapy

    • Cephalosporin:

    • Amino glycosides: Gentamycin


    • Note: UTI, urinary tract infection; TMP, trimethoprim; TMP-SMX, trimethoprim-sulfamethoxazole.
    Urinary Antiseptics
    • rapidly excreted in the urine and suppress the bacterial growth
    • more effective in acidic urine because low pH is an independent inhibitor
    of bacterial growth.

    • Nitrofurantoin: result in DNA damage. It is active against most urinary


    pathogens except pseudomonas and proteus. Resistance against it
    develops slowly.
    • Adverse effects include diarrhea, phototoxicity, neurotoxicity and
    hemolysis in G-6-PD deficient patients.
    • Methanamine Mandelate:
    • It release formaldehyde at low pH , which is the major compound
    having antibacterial activity.
    • This drug is not effective against proteus because it releases NH3 and
    alkalinizes the urine.

    • Insoluble complex forms between formaldehyde and sulfonamides, so methanamine should not
    be used with sulfonamides.
    Nalidixic Acid
    This is a quinolone drug and acts by inhibiting DNA gyrase.
    This too is not effective against pseudomonas and proteus.
    Resistance emerges rapidly and main adverse effect is neurotoxicity.

    Phenazopyridine: It is not a urinary antiseptic but possesses analgesic


    action and alleviates symptoms of dysuria, frequency, burning and
    urgency.
    Urinary pH in relation to use of AMAs
    • Most drugs used in UTI attain high
    concentration in urine and minor
    changes in urinary pH do not
    affect clinical outcome. In case of
    inadequate response or in
    complicated cases, measurement
    of urinary pH may help
    • In urease positive Proteus
    infections ; impossible to acidify
    urine; acidification should not be
    attempted; drugs which act better
    at higher pH should be used.
    Bacteriuria in pregnancy
    • To prevent from pyelonephritis
    • 7 days course with:
    • Cephalexin
    • Nitrofurantoin
    • Amoxicillin
    • SAQ:
    • List the drugs used in the management of Urinary tract infections
    • Write short notes on Urinary antiseptics

    MCQ (Important)
    • Phenazopyridine: It is an orange dye with no urinary antiseptic but
    analgesic property
    • Nalidixic acid: quinolone drug and acts by inhibiting DNA gyrase
    • Methanamine Mandelate: It release formaldehyde at low pH
    • Nitrofurantoin can cause hemolysis in G-6-PD deficient patients.
    Thank you

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