1. The document discusses urinary tract infections (UTIs), including the anatomy of the urinary tract and classifications of UTIs like cystitis, pyelonephritis, urethritis, and prostatitis.
2. Common causative organisms of UTIs are E. coli, Staphylococcus saprophyticus, and various gram-negative bacteria associated with catheters. Antibiotics commonly used to treat UTIs include trimethoprim-sulfamethoxazole, fluoroquinolones like ciprofloxacin, and intravenous antibiotics for severe infections.
3. Fungal UTIs can be caused by Candida species and other fungi like Blastomyces and As
1. The document discusses urinary tract infections (UTIs), including the anatomy of the urinary tract and classifications of UTIs like cystitis, pyelonephritis, urethritis, and prostatitis.
2. Common causative organisms of UTIs are E. coli, Staphylococcus saprophyticus, and various gram-negative bacteria associated with catheters. Antibiotics commonly used to treat UTIs include trimethoprim-sulfamethoxazole, fluoroquinolones like ciprofloxacin, and intravenous antibiotics for severe infections.
3. Fungal UTIs can be caused by Candida species and other fungi like Blastomyces and As
1. The document discusses urinary tract infections (UTIs), including the anatomy of the urinary tract and classifications of UTIs like cystitis, pyelonephritis, urethritis, and prostatitis.
2. Common causative organisms of UTIs are E. coli, Staphylococcus saprophyticus, and various gram-negative bacteria associated with catheters. Antibiotics commonly used to treat UTIs include trimethoprim-sulfamethoxazole, fluoroquinolones like ciprofloxacin, and intravenous antibiotics for severe infections.
3. Fungal UTIs can be caused by Candida species and other fungi like Blastomyces and As
1. The document discusses urinary tract infections (UTIs), including the anatomy of the urinary tract and classifications of UTIs like cystitis, pyelonephritis, urethritis, and prostatitis.
2. Common causative organisms of UTIs are E. coli, Staphylococcus saprophyticus, and various gram-negative bacteria associated with catheters. Antibiotics commonly used to treat UTIs include trimethoprim-sulfamethoxazole, fluoroquinolones like ciprofloxacin, and intravenous antibiotics for severe infections.
3. Fungal UTIs can be caused by Candida species and other fungi like Blastomyces and As
3 Urinary Tract Infection (UTI) Background 1. Bacterial infections of urinary tract are a very common reason to seek health services 2. Common in young females and uncommon in males under age 50 3. Common causative organisms a. Escherichia coli (gram-negative enteral bacteria) causes most community acquired infections b. Staphylococcus saprophyticus, gram-positive organism causes 10 15% c. Catheter-associated UTIs caused byA gram-negative bacteria: Proteus, Klebsiella, Seratia, Pseudomonas 4 Urethritis Chlamydia trachomatis Frequently asymptomatic in females, but can present with dysuria, discharge or pelvic inflammatory disease. Send UA, Urine culture (if pyuria seen, but no bacteria, suspect Chlamydia) Pelvic exam send discharge from cervical or urethral os for chlamydia PCR Chlamydia screening is now recommended for all females 25 years Treatment: Azithromycin 1 g po x 1 Doxycycline 100 mg po BID x 7 days
5 Neisseria gonorrhoeae May present with dysuria, discharge, PID Send UA, urine culture Pelvic exam send discharge samples for gram stain, culture, PCR Treatment: Ceftriaxone 125 mg IM x 1 Cipro 500 mg po x 1 Levofloxacin 250 mg po x 1 Ofloxacin 400 mg po x 1 Spectinomycin 2 g IM x 1 You should always also treat for chlamydia when treating for gonnorhea!
6 Urinary Tract Infection (UTI) Medications a. Short-course therapy: 3 day course of antibiotics for uncomplicated lower urinary tract infection; (single dose associated with recurrent infection) b. 7 10 days course of treatment: for pyelonephritis, urinary tract abnormalities or stones, or history of previous infection with antibiotic-resistant infections; clients with severe illness may need hospitalization and intravenous antibiotics c. Antibiotics commonly used for short and longer course therapy include trimethoprim-sulfamethoxazole (TMP-SMZ), or quinolone antibiotic such as ciprofloxacin (Cipro) d. Intravenous antibiotics used include ciprofloxacin, gentamycin, ceftriaxone (Rocephin), ampicillin 7 Final thoughts! Antibiotic choice and duration are determined by classification of UTI. Biggest bugs for UTI are E. Coli, Staph. Saprophyticus, Proteus mirabilis, Enterococci and gram-negatives Dont use moxifloxacin for UTI! Chlamydia screening is now recommended for all women 25 years and under since infection is frequently asymptomatic, and risk for PID/infertility is high! 8 Principles of management of acute severe urinary tract infections 9 ANTIBIOTIC THERAPY - PRINCIPLES OF MANAGEMENT
Ideal antibiotic Achieve high renal tissue and urine levels Bactericidal Broad spectrum of activity Common drugs : gentamicin, ciprofloxacin, trimethoprim/sulfamethoxazole, amoxicillin and the cephalosporins. Chlamydiae and mycoplasmas : Tetracyclines and erythromycin. Trichomonas vaginalis : Metronidazole. 10 Gentamicin Most suitable antimicrobial Bactericidal activity Combination with -lactams and vancomycin Added advantage of synergistic activity. Increase the diffusion of gentamicin across bacterial cell membranes thereby improving efficacy. Post-antibiotic effect with a large once daily dose producing bacteriostasis several hours after dosage. pregnancy, diabetes mellitus, anatomical variation, urolithiasis, neuropathy, renal impairment, hepatic impairment, immunosuppression and age. 11 Bacterial antibiotic resistance Three mechanisms 1.Natural resistance occurs with the absence of any drug- sensitive strains prior to the initiation of therapy. 2.Resistant mutants - up to 10% , within 48 h of antibiotic treatment. Bacterial transport molecules and molecules aiding the binding of antibiotics to bacterial proteins, eg. 30S ribosomal subunit binding to gentamicin. 3.Plasmid-mediated resistance (R-factor) Most important mechanism of bacterial resistance - transfer of multidrug resistance (MDR) genes leading to the production of 'killer' enzymes. Important to obtain periodic advice from regional clinical microbiologists/infectious diseases physician if empiric treatment of UTIs is contemplated. Choice of antimicrobials, adjustments in dosage and length of treatment by coexisting conditions
12 Antibiotics used in the management of urinary tract infections 13 Fungal Urinary Tract Infections Diagnosis and Management 14 Candida species - saprophytes of the skin, oropharyx ,gasrointestinal tract and genital regions. Blastomyces, Histoplasmosis, Coccidoides Mucormycosis
Apergillosis Fungus yang sering sebagai penyebab UTI 15 Treatment Bladder irrigation with Amphotericin B 50mg/1L water x10-14 d Effective in 80-92% of patients Nystatin and Miconazole useful. -poor colloid dispersion in Nystatin-limits use Surgical intervention may be required in the form of mucosal debridement Removal of large fungal bezoars if present.
16 Treatment Localized Amphotericin B irrigation for infection of the collecting system..
Systemic or multifocal infection IV Ampho B 6mg/kg (Gold Standard) , Fluconazole 100mg BID x 10 days 5-FC- 150mg/kg- high resistance
17 Cryptococosis Tx: Adrenal-Amphotericin B Renal- IV Amphotericin B Prostate-Fluconazole 200-600mg/d x 4 wks Penis- Resection followed by systemic Ampho B
18 Apergillosis Predisposition: abraded skin, wounds, cornea, ext. ear and sinuses, immunocompromised GU involvement: Renal- DM, malignancy or AIDS (Fever, CVAT, obstructive uropathy) Prostate and Genital-DM, Met colon ca, steroid use & AIDS DX:Isolation from urine,semen or tissue.
19
Dx- Identification of organism in urine,semen or tissue. Culture or skin test. Tx- IV Amphotericin B(>2g) total dose followed by long term Itraconazole 200mg/d x12 wks Surgical management- Surgical excision or drainage of prostate abscess.
20 Blastomyces
Organism: Blastomyces dermatitidis Properties: Dimorphic, m
old in soil, yeast in tissue Broad-based budding Epidemiology: North and Central America, also Africa. Grows in moist soil.
21 Mucormycosis
Manifestations- primarily rhino cerebral, sinusitis and brain hemorrhage GU- Primarily fever and flank pain Dx- biopsy showing mold with nonseptate hyphae Tx-IV amphotericin B >1gram for 1 month
22 23 24 Dasar-dasar pengobatan keradangan saluran kemih Keradangan saluran kemih biasanya diobati dengan antibiotika atau khemoterapetika selama 10-14 har dengan konsentrasi tinggi didalam urin untuk dapa menghasikan yang efektif. Obat antibiotika atau khemoterapetika yang bekerja dalam konsentrasi tinggi didalam urin lebih lemah dibandingkan obat-obat yang konsentrasinya lebih tinggi didalam darah Cystitis yang tidak melibatkan sel-sel parenchym mudah diobati dengan obat-obat yang yang banyak terdapat dalam urin 25 Kriteria keberhasilan pengobatan setelah 48 jam urin itu steril, hilangnya lekosit, , hilangnya nyeri waktu buang air kecil dan di pinggul, jumalh sel-sel darah putih normal Ketidak berhasilan pengobatan UTI terjadi oleh n amyak hal, seperti terjadinya mixed infection, salah diagnosis 26 A. Keradangan saluran kemih akut Obat yang paling manjur untuk UTI adalahamoxycillin atau cotimozasol. Lamanya pengobatan paling kurang 10-14 hari. Pembetian satu dosis perhari. Pengobatan yang tak diketahui kuman patogennya, harus dimula waaupun belum diketahui penyebabnya. Dimulai pemberian amoxycillin, bacampicillin atau co-trimoxazols. Cefotaxime atau suatu turunan minglikosida efektif juga. 27 B. Pengobatan Pyelonefritis neys
Pyelonefritis ditandai demam dan lekositosis, nyeri panggul bila di perkusi dapat menyebabkan septikemia. Penyebabnya adalah mekanikal ( batu, obstruksi) Amoxicillin Cephalosporin Levofloxacin and ciprofloxacin Sulfa drugs such as /trimethoprim In acute cases, you may receive a 10- to 14-day course of antibiotics. 28 2. Cystitis Acute cystitis is a bacterial infection of the bladder or lower urinary tract Commonly used antibiotics include trimethoprim-sulfamethoxazole, amoxicillin, Augmentin, doxycycline, and fluoroquinolones. Your doctor will also want to know whether you are pregnant. 29 3. Urethritis Urethritis is inflammation of the urethra Pain with urination is the main symptom of urethritis. Urethritis is commonly due to infection by bacteria. It can typically be cured with antibiotics. E. coli and other bacteria present in stool. Gonococcus. It is sexually transmitted and causes gonorrhea. Chlamydia trachomatis. It is sexually transmitted and causes chlamydia. 30 4. Prostatitis,, orchitis There are four types of prostatitis: acute bacterial prostatitis chronic bacterial prostatitis chronic prostatitis without infection asymptomatic inflammatory prostatitis Acute bacterial prostatitis treatment Treatment for acute bacterial prostatitis is a prescription for antibiotics by mouth, usually ciprofloxacin (Cipro) or tetracycline (Achromycin). Home care includes drinking plenty of fluids, medications for pain control, and rest.
Chronic prostatitis without infection treatment Chronic prostatitis without infection treatment addresses chronic pain control and may include physical therapy and relaxation techniques as well as tricyclic antidepressant medications.
prostatitis 31 epididymitis Epididymitis is infection or less frequently, inflammation of the epididymis (the coiled tube on the back of the testicle). because of a bacterial infection. Ceftriaxone (Rocephin): As a single dose either in an IM (intramuscular) shot or through an IV line and 1 dose of azithromycin (Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax, Zithromax TRI-PAK, Zithromax Z-Pak, Zmax) Doxycycline (Vibramycin): Pills twice a day for 10 days in addition to the shot of ceftriaxone The CDC guidelines recommend ceftriaxone (Rocephin) 250 IM in a single dose plus doxycycline 100 mg orally twice a day for 10 days. Ciprofloxacin (Cipro): Pills twice a day for 10-14 days Ofloxacin (Floxin): Pills twice a day for 10-14 days Sulfamethoxazole and trimethoprim (Bactrim DS [double strength]): Pills twice a day for 10-14 days 32