Urinary Tract Infection

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.