Uti -for_non-urologists-uncomplicated and complicated

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  • 1. Urinary Tract Infection
  • 2. Urinary Tract Infection (UTI) • UTI is the 2nd most common infectious presentation in community practices • World wide, about 150 million people are diagnosed with UTI each year Ann Clin Micr Anti 2007;6:4-12
  • 3. UTI is an inflammatory response of the urothelium to bacterial invasion Campbells Urology 2007; 9th Ed Urinary Tract Infection (UTI) UTI can occur in females and males, in all age groups
  • 4. Prevalence 35% of healthy women suffer symptoms of UTI at some time in their life Common in women Medicine 2007;35:423-427
  • 5. Why greater susceptibility of UTI in women? The female urethra • short length (~4cm) • proximity to anus Urethra is prone to colonization with bacteria (Fecal bacteria) Medicine 2007;35:423-427
  • 6. Prevalence • Rare in Males • Anatomical or functional abnormality of the urinary tract 8% of girls and 2% of boys will have UTI in childhood • Increases in elderly • 21% of women and 12% of men over 65 yrs of age have UTI Medicine 2007;35:423-427 BMJ 1999;319:1173-1175
  • 7. Pathogenesis Most UTI occur in women who are healthy Interaction between the bacterial virulence and host defence Increase in virulence Decrease in host defence Infection+ Medicine 2007;35:423-427
  • 8. Routes of Infection Common route – Ascending through urethra Other route – Blood and lymphatic EAU Guidelines 2006
  • 9. UTI Community acquired UTI Nosocomial UTI UTI - Classification EAU Guidelines 2006
  • 10. Uncomplicated UTIs Complicated UTIs Infection involving normal urinary tract Presence of metabolic, anatomic and functional abnormalities UTI UTI - Classification EAU Guidelines 2006 Healthy non-pregnant women • Pregnancy • Catheterization • Diabetes • Infection stones
  • 11. Site of origin Epididymitis Prostatitis Pyelonephritis Cystitis Urethritis UTI - Classification Orchitis EAU Guidelines 2006
  • 12. Risk factors associated with UTIs Uncomplicated Complicated • Sexual intercourse • Spermicide creams • Diaphragm • Previous UTI • Pregnancy • Catheterization • Diabetes • Infection stones • Male • Elderly Medicine.2007;35:423-427
  • 13. Clinical presentation of Uncomplicated UTI Common symptomatic infection in young non-pregnant women is uncomplicated cystitis • Asymptomatic bacteriuria • Acute Cystitis • Acute Pyelonephritis EAU Guidelines 2006
  • 14. Causative organisms Acute Uncomplicated cystitis E.Coli : 70- 95% Staphylococcus.saprophyticus :10-15% Klebsiella species Proteus mirabilis Arch Intern Med.2007;167:2207-12
  • 15. Causative organisms Acute Uncomplicated pyelonephritis E.Coli – 80% Klebsiella species Proteus mirabilis Other enterobacteria Staphylococcus aureus Prim Care Clin Office Pract 2008;35:345-367
  • 16. Symptoms of Uncomplicated cystitis If both dysuria and frequency present in the absence of vaginal discharge, the chance of UTI is ~90% • Dysuria • Frequency • Urgency • Hematuria • Suprapubic pain Campbells Urology 2007; 9th Ed
  • 17. Symptoms of Uncomplicated pyelonephritis • Fever • Flank pain • Nausea • Vomiting • Abdominal pain The patient may or may not have symptoms of cystitis Prim Care Clin Office Pract 2008;35:345-367
  • 18. Diagnosis History • Symptoms of UTI • Other History (eg. Vaginal discharge) Examination Pelvic examination to rule out other causes like urethritis and vaginitis EAU Guidelines 2006
  • 19. Diagnosis Urine Analysis -Dipstick method • Nitrite • Leukocyte esterase - Microscopic analysis • Bacteriuria • Pyuria • Hematuria EAU Guidelines 2006
  • 20. Diagnosis Urine Culture Not recommended in case of cystitis but done if pyelonephritis suspected or complicated UTI Ultrasonography CT scan EAU Guidelines 2006
  • 21. Treatment for Uncomplicated Cystitis Short term antibiotics ( EAU recommendation - Drugs of first choice) Drug Dose Duration NitrofurantoinNitrofurantoin macrocrystalsmacrocrystals 100mg, bid100mg, bid 5-7days5-7days Fosfomycin trometamol° 1 day 3 g SD 1day1day Pivmecillinam Pivmecillinam 400 mg bid 200 mg bid 3 days 7 days EAU Guidelines 2010
  • 22.  Ciprofloxacin 250 mg bid 3 days (CIPLOX)  Levofloxacin 250 mg qd 3 days (LEVOFLOX)  Norfloxacin 400 mg bib 3 days (NORFLOX)  Ofloxacin 200 mg bid 3 days  Cefpodoxime proxetil 100 mg bid 3 days (CEFOPROX)  If local resistance pattern is known (E. coli resistance < 20%):  Trimethoprim–sulphamethoxazole 160/800 mg bid 3 days  Trimethoprim 200 mg bid 5 days Treatment for Uncomplicated Cystitis (Alternatives) EAU Guidelines 2010
  • 23.  Oral therapy in mild and moderate cases  Ciprofloxacin 500–750 mg bid 7–10 days  Levofloxacin 250–500 mg qd 7–10 days  Levofloxacin 750 mg qd 5 days  Alternatives (clinical but not microbiological equivalent efficacy compared with fluoroquinolones):  Cefpodoxime proxetil 200 mg bid 10 days  Ceftibuten 400 mg qd 10 days  Only if the pathogen is known to be susceptible (not for initial empirical therapy): o Trimethoprim–sulphamethoxazole 160/800 mg bid 14 days o Co-amoxiclav 0.5/0.125 g tid 14 days Treatment for Uncomplicated Pyelonephritis Recommendations as per EAU guidelines EAU Guidelines 2010
  • 24. Treatment for Uncomplicated Pyelonephritis In severe cases of pyelonephritis • Hospitalization • Parenteral antibiotics (Quinolones and beta lactamase inhibitor) • With improvement switch to oral therapy to complete the course EAU Guidelines 2006
  • 25. Choice of antibiotics should take into account not only the spectrum of activity but also resistance
  • 26. Susceptibility Patterns ofSusceptibility Patterns of E.ColiE.Coli from 2003-2007from 2003-2007 International dataInternational data 0 20 40 60 80 100 120 E.coli-2003 E.Coli-2004 E.Coli-2005 E.Coli-2006 E.Coli-2007 Average TMP/Sulfa Ciprofloxacin Levofloxacin Nitrofurantoin %Susceptability J Urol 2008;178:84 E.coli has highest susceptibility for Nitrofurantoin
  • 27. Susceptibility patterns of E.coli to various antibiotics : Indian data 0 10 20 30 40 50 60 70 80 90 100 T/S A Nx Cf G Ce Ci Nf T/S- Trimethoprim/Sulfamethoxazole; A- Ampicillin; Nx-Norfloxacin; Cf-Ciprofloxacin; G-Gentamicin; Ce-Cefotaxime; Ci-Ceftriaxone; Nf-Nitrofurantoin Indian J Med Sci 2006;60:53-58 E.coli has highest susceptibility for Nitrofurantoin
  • 28. Resistance • Infecting organisms are not susceptible to antimicrobial agent selected • Invariably patient has received recent antimicrobial therapy which produces resistance Campbells Urology 2007; 9th Ed
  • 29. Incidence of recurrenceIncidence of recurrence • One in four women will develop recurrence • 27% of women will experience a recurrence within 6-12 months Best Pract Res Clin Obstet Gynaecol 2005;19:861-873
  • 30. Resistance rates in E coli: International data 38 21 6 1 0 5 10 15 20 25 30 35 40 Ampicillin TMP-SMX Cipro Nitro ResistanceratesinEcoli% Urol Clin Am;2008:35:69-79 Nitrofurantoin has least resistance compared to other commonly used antibiotics
  • 31. Resistance to TMP-SMX is more than 75% Resistance rates in E coli: Indian data More than 80% of the fluoroquinolone resistant strains were found to be sensitive to Nitrofurantoin Indian J Med Sci 2006;60:53-58 Resistance to Fluoroquinolones is as high as 69% Prim Care Clin Office Pract 2008;35:345-367
  • 32. Follow-up Urine Analysis - Bacteriuria Urine culture - If symptoms do not resolve or recur within 2 weeks EAU Guidelines 2006
  • 33. Recurrence Recurrent UTI is defined as 3 episodes of UTI in the last 12 months or 2 episodes in the last 6 months Recurrent UTI occur in 20-25% of women Risk Factors  History of UTI in mother  Behavioural factors - Frequency of sexual intercourse - Spermicide cream - Diaphragm EAU Guidelines 2006 Medicine.2007;35:423-427
  • 34. Prophylaxis for Recurrent UTI Pharmacological - Antibiotic prophylaxis Non Pharmacological - Voiding after intercourse - Cranberry juice - Alkalizer (Potassium citrate) EAU Guidelines 2006
  • 35. Antibiotic prophylaxis Long term prophylactic antimicrobials - Taken regularly at bedtime Post coital prophylaxis - When related to sexual intercourse 95% decrease in UTI episodes/pt year EAU Guidelines 2006
  • 36. EAU Guidelines 2010 Long term prophylactic antimicrobials Taken at bedtime Drug Dose NitrofurantoinNitrofurantoin 50/100mg/day50/100mg/day TMP-SMXTMP-SMX 40/200mg/day or three times weekly40/200mg/day or three times weekly CefaclorCefaclor 250mg/day250mg/day CephalexinCephalexin 125/250mg/day125/250mg/day NorfloxacinNorfloxacin 200mg/day200mg/day CiprofloxacinCiprofloxacin 125mg/day125mg/day Fosfomycin 3 g every 10 days
  • 37. Post coital prophylaxis EAU Guidelines 2010 Drug Dose TMP-SMXTMP-SMX 40/200mg40/200mg NitrofurantoinNitrofurantoin 50/100mg50/100mg CephalexinCephalexin 250mg250mg CinoxacinCinoxacin 250mg250mg CiprofloxacinCiprofloxacin 125mg125mg NorfloxacinNorfloxacin 200mg200mg OfloxacinOfloxacin 100mg100mg
  • 38. 0 10 20 30 40 50 60 70 80 90 Noofpatients No of symptomatic episodes Long term prophylaxis with nitrofurantoin for 1year (18 years of experience) Significantly higher no of patients had no symptomatic episodes of UTI J Antimicrob Chemother.1998;42: 363-371 0 1 2 3 4 5 6 7 8
  • 39. Nitrofurantoin has maintained its place in the treatment of UTI due to least resistance
  • 40. Different forms of Nitrofurantoin • Nitrofurantoin Microcrystalline - Introduced in 1953 • Nitrofurantoin Macrocrystals - Introduced in 1968 • Nitrofurantoin Monohydrate/Macrocrystals - Novel formulation J Antimicrob Chemother.1998;42: 363-371
  • 41. Nitrofurantoin Microcrystalline form had Limitations like Nitrofurantoin Macrocrystalline form superior to Nitrofurantoin Microcrystal form - Severe GI side effects like nausea and vomiting - Four times daily dosing - Better GI tolerability Nitrofurantoin Monohydrate/Macrocrystal superior to both - Better GI tolerability - BID dosing J Antimicrob Chemother.1998;42: 363-371
  • 42. 0 10 20 30 40 50 60 70 BID QID Compliance(%) BID dosing associated with significantly better compliance than QID dosing Nitrofurantoin monohydrate/macrocrystals Nitrofurantoin microcrystalline J Antimicrob Chemother.1998;42: 363-371
  • 43. Nitrofurantoin Monohydrate/Macrocrystals provides BID dosing and retains the efficacy and safety profiles of Nitrofurantoin macrocrystals J Antimicrob Chemother.1998;42: 363-371
  • 44. Complicated UTI • Pregnancy • Diabetes • Paediatric UTI • Catheter associated urinary tract infection (CAUTI) • Prostatitis
  • 45. UTI in PregnancyUTI in Pregnancy
  • 46. Pregnancy UTIs are detected in 2 to 8% of pregnant women Clinical presentation • Asymptomatic • Symptomatic - Cystitis - Pyelonephritis Risks - Low birth weight baby - Low gestational age (<37 weeks) and Prematurity - Neonatal mortality EAU Guidelines 2006
  • 47. Recommended treatment regimens for asymptomatic bacteriuria and cystitis in pregnancy Antibiotic Comments Nitrofurantoin monohydrate / macrocrystals Avoid in G6PD deficiency 100 mg q12 h, 3–5 days Amoxicillin Increasing resistance 500 mg q8 h, 3–5 days Co-amoxicillin/clavulanate 500 mg q12 h, 3–5 days Cephalexin 500 mg q8 h, 3–5 days Increasing resistance Fosfomycin 3 g Single dose Trimethoprim–sulfamethoxazole Avoid trimethoprim in q12 h, 3–5 days first trimester/term and sulfamethoxazole in third trimester/term EAU Guidelines 2010
  • 48. Recommended treatment regimens for pyelonephitis in pregnancy  Ceftriaxone 1–2 g IV or IM q24 h  Aztreonam 1 g IV q8–12 h  Piperacillin–tazobactam 3.375–4.5 g IV q6 h  Cefepime 1 g IV q12 h  Imipenem–cilastatin 500 mg IV q6 h  Ampicillin 2 g IV q6 h + gentamicin 3–5 mg/kg/day IV in 3 divided doses Outpatient management with appropriate antibiotics should be considered provided symptoms are mild and close follow-up is feasible
  • 49. UTI in DiabetesUTI in Diabetes
  • 50. Diabetes Prevalence of UTI is 26% in women with diabetes compared with 6% in those without diabetes Clinical presentation • Asymptomatic • Symptomatic - Cystitis - Pyelonephritis Risks Upper tract involvement in diabetes (pyelonephritis) is 5-fold more frequent than in non diabetics and can lead to serious complications like: • Renal and perinephric abscess • Papillary necrosis Int J Anti Agents 2000;15: 247-256
  • 51. Diabetes Causative organisms E.Coli - 75% Klebsiella Enterobacter S.faecalis Fungi Int J Anti Agents 2008;31S:S54-S57
  • 52. Asymptomatic: Screening and treatment not warranted Treatment for UTI in diabetic patients Symptomatic: • Long term antibiotics (7-14 days) - Amoxicillin - Nitrofurantoin -TMP/SMX - Ciprofloxacin • Choice of antimicrobials is similar in diabetic and non diabetics • Commonly prescribed antibiotics • TMP/SMX is not a good first choice as in addition to high resistance it can lead to hypoglycemia Int J Anti Agents 2008;31S:S54-S57
  • 53. Paediatric UTIPaediatric UTI
  • 54. UTI in Children
  • 55. Incidence of pediatric UTI Pediatr Clin N Am 2006;53:379-400 Age (Y)Age (Y) Female (%)Female (%) Male (%)Male (%) < 1< 1 0.70.7 2.72.7 1- 51- 5 0.9-1.40.9-1.4 0.1- 0.20.1- 0.2 6-166-16 0.7- 2.30.7- 2.3 0.04- 0.20.04- 0.2
  • 56. Risk factors for pediatric UTI • Neonate /Infant • Urinary tract anomalies (Vesicoureteral reflux) • Functional abnormalities (Neurogenic bladder) • Immunocompromised states Pediatr Clin N Am 2006;53:379-400
  • 57. Clinical presentation Pediatric UTI • Asymptomatic • Symptomatic - Cystitis - Pyelonephritis Risks • Poor renal growth • Recurrent pyelonephritis • Hypertension • End Stage Renal Disease (ESRD) Pediatr Clin N Am 2006;53:379-400
  • 58. Classification of pediatric UTI Urinary Tract Infection First Infection Recurrent Infection Unresolved Bacteriuria Bacterial Persistance Reinfection Pediatr Clin N Am 2006;53:379-400
  • 59. Classification of pediatric UTI Severe UTI Simple UTI Fever ≥ 39°CFever ≥ 39°C Mild pyrexiaMild pyrexia Persistent vomitingPersistent vomiting Good fluid intakeGood fluid intake Serious dehydrationSerious dehydration Slight dehydrationSlight dehydration EAU Guidelines 2006
  • 60. Diagnosis of pediatric UTI Physical Examination + Urinalysis/Urine culture > 2 UTI episodes in girls > 1 UTI episodes in boys Imaging tests EAU Guidelines 2006
  • 61. Treatment of pediatric UTI Severe UTI Simple UTI Parental therapy until afebrile • Adequate hydration • Cephalosporins (3rd generation) • Amoxycillin/clavulanate if cocci are present Oral therapy Parental single-dose therapy (only in case of doubtful compliance) • Cephalosporins (3rd generation) • Gentamicin Oral therapy to complete 10-14 days of treatment Oral therapy to complete 5-7 days of treatment EAU Guidelines 2006
  • 62. Oral antimicrobials for pediatric UTI Drug Dose (mg/kg/d) Frequency CephalexinCephalexin 25-5025-50 q 6 hq 6 h CefaclorCefaclor 2020 q 8 hq 8 h CefiximeCefixime 88 q 12-24 hq 12-24 h CefadroxilCefadroxil 3030 q 12-24 hq 12-24 h NitrofurantoinNitrofurantoin 5-75-7 q 6 hq 6 h AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h AmoxicillinAmoxicillin 20-4020-40 q 8 hq 8 h Pediatr Clin N Am 2006;53:379-400
  • 63. Drug Dose (mg/kg/d) Frequency CefazolinCefazolin 25-5025-50 q 6-8 hq 6-8 h CefotaximeCefotaxime 50-18050-180 q 4-8 hq 4-8 h CeftriaxoneCeftriaxone 50-7550-75 q 12-24 hq 12-24 h CeftriazidimeCeftriazidime 90-15090-150 q 8-12 hq 8-12 h CefepimeCefepime 100100 q 12 hq 12 h AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h GentamicinGentamicin 7.57.5 q 8 hq 8 h Parenteral antimicrobials for pediatric UTI Pediatr Clin N Am 2006;53:379-400
  • 64. Antibiotic prophylaxis for Pediatric UTI If there is an increased risk of UTI due to congenital abnormalities, low dose prophylaxis is recommended Drug Daily dosage (mg/kg/d) Age limitation CephalexinCephalexin 2-32-3 NoneNone NitrofurantoinNitrofurantoin 1-21-2 >1 month>1 month TMP-SMXTMP-SMX 1-21-2 >2 month>2 month Pediatr Clin N Am 2006;53:379-400
  • 65. Catheter Associated Urinary Tract Infections (CAUTI)
  • 66. Catheter Associated Urinary Tract Infections (CAUTI)  The most common nosocomial infection ( 40 %)  Causes bacteremia in 2-4 % of patients  Risk factors  Increasing duration of use  Female sex  Absence of antibiotics  Disconnection of catheter-collecting tube junction American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
  • 67. CAUTI – Pathogenesis Two routes of entry- • Periurethral Common in females Bacteria from rectal flora – Ecoli • Intraluminal Common in men Pseudomonas, Proteus etc American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
  • 68. Intraluminal Route : Pathogenesis BACTERIA Attached to inner surface of catheter Growing within urine itself BIOFILM Planktonic growth American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
  • 69. Biofilm Formation Bacteria attached to inner surface of catheter Sheets of organisms coat cather Secrete extracellular matrix of bacterial glycocalyces Tamm-Horsfall protein and urinary salts are incorporated in biofilm growth Encrustation of catheter & catheter obstruction Psudomonas are highly associated with propensity to form biofilm. American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
  • 70. BIOFILM FORMATION PLANKTONIC BACTERIA ATTACHMENT MICROCOLONIES BIOFILM COMMUNITY Arch Intern Med / Vol.164,Apr 26,2004
  • 71.  Decreased susceptibility to antibioticsDecreased susceptibility to antibiotics • Physical impairment of diffusion of antibiotic agentPhysical impairment of diffusion of antibiotic agent • Trapping of antibiotic within matrixTrapping of antibiotic within matrix • Increased resistance rateIncreased resistance rate  Misleading microbiological laboratory resultMisleading microbiological laboratory result  Lacking of intrinsic defense systemLacking of intrinsic defense system Clinical ImplicationClinical Implication Arch Intern Med / Vol.164,Apr 26,2004
  • 72.  The duration of catheterisation should be minimal  Prophylactic antibiotics and Chronic antibiotic suppressive therapy is generally not recommended PreventionPrevention EAU Guidelines 2010
  • 73. Treatment for CAUTITreatment for CAUTI • In case of symptomatic CAUTI, replace or remove the catheter before starting antimicrobial therapy if the indwelling catheter has been in place for > 7 days • For empirical therapy, broad-spectrum antibiotics should be given based on local susceptibility patterns • After culture results are available, antibiotic therapy has to be adjusted according to sensitivities of the pathogens EAU Guidelines 2010
  • 74. ProstatitisProstatitis
  • 75.  Most common urological diagnosis in men < 50Most common urological diagnosis in men < 50 years and the third most common > 50 yearsyears and the third most common > 50 years  10% of men have prostatitis like symptoms10% of men have prostatitis like symptoms  Life time probability > 25%Life time probability > 25%  Rates are similar in Asia, USA and EuropeRates are similar in Asia, USA and Europe Prostatitis : How big is the problem?Prostatitis : How big is the problem?
  • 76. Diagnosis: Quantitative segmental bacterialDiagnosis: Quantitative segmental bacterial localization culture (Meares and Stamey)localization culture (Meares and Stamey)
  • 77. NIH Classification of ProstatitisNIH Classification of Prostatitis CasesCases (%)(%) Mid streamMid stream Urine sepcimenUrine sepcimen WBCWBC CultureCulture ProstaticProstatic specimen (EPSspecimen (EPS or VB3)or VB3) WBCWBC CultureCulture ABP (I)ABP (I) < 1< 1 ++ +++ + ++ +++ + CBP(II)CBP(II) 5-105-10 + ++ + + ++ + CP/CPPS(III)CP/CPPS(III) Inflammatory (IIIA)Inflammatory (IIIA) NonNon inflammatory(IIIB)inflammatory(IIIB) 80-9080-90 - -- - - -- - + -+ - - -- - AIPAIP (asymptomatic(asymptomatic inflammatoryinflammatory prostatitis)prostatitis) 1010 + -+ - - -- -
  • 78. Which antibiotics?Which antibiotics? Prerequisites for use of antibiotics for CBPPrerequisites for use of antibiotics for CBP • Active against expected pathogens • Effective penetration into the prostatic tissue • Well tolerated – prolonged therapy (up to 12 weeks) • Convenient to take
  • 79. Pathogens causing CBPPathogens causing CBP Generally acceptedGenerally accepted  Escherichia coliEscherichia coli (50-80%)(50-80%)  Klebsiella pneumoniaeKlebsiella pneumoniae  Proteus miribalisProteus miribalis  PseudomonasPseudomonas aeruginosaaeruginosa  Enterococcus faecalisEnterococcus faecalis PotentialPotential  StaphylococcusStaphylococcus saprophyticussaprophyticus  Staphylococcus aureusStaphylococcus aureus  StaphylococcusStaphylococcus epidermidisepidermidis  StreptococcusStreptococcus  Mycoplasma genitaliumMycoplasma genitalium  Ureaplasma urealyticumUreaplasma urealyticum  Chlamydia trachomatisChlamydia trachomatis Campbells Urology, 9th edition
  • 80. TreatmentTreatment Chronic Bacterial ProstatitisChronic Bacterial Prostatitis • favourable pharmacokinetic properties • excellent penetration in prostatic tissue • antibacterial activity against gram negative pathogens, including Pseudomonas aeruginosa as well as gram positive pathogens • good safety profile EAU Guidelines 2010 Eur Urol Suppl 2007;6(2):72 Fluoroquinolones such as ciprofloxacin, levofloxacin and prulifloxacin may be considered as drugs of choice because of their:
  • 81. Prulifloxacin 600 mg VsPrulifloxacin 600 mg Vs Levofloxacin 500 mg in CBPLevofloxacin 500 mg in CBP  At 2 weeks there was aAt 2 weeks there was a greater reduction ingreater reduction in symptom scoressymptom scores  At 6 months 5 patients onAt 6 months 5 patients on Prulifloxacin had a positivePrulifloxacin had a positive Meares-Stamey test Vs 11Meares-Stamey test Vs 11 in the levofloxacin groupin the levofloxacin group  Well toleratedWell tolerated N =96, 4 weeks treatment Prulifloxacin is as effective and safe as levofloxacin In the treatment of CBP With prulifloxacin there was trend to an earlier resolution of symptoms. Eur Urol Suppl 2007;6(2):72
  • 82. Highlights • UTI is the common infection occurring in young women • The most common presentation in young non-pregnant women is acute uncomplicated cystitis • The recommended treatment for acute uncomplicated cystitis Is short course with antimicrobials like: - Fosfomycin - Nitrofurantoin - TMP/SMX • The most common pathogen causing UTI is E.coli
  • 83. Highlights • Choice of antibiotics should take into account not only the spectrum of activity but also resistance • E.Coli has highest susceptibility and least resistance for nitrofurantoin as compared to other commonly used antimicrobials • Nitrofurantoin has maintained its place in the management of Uncomplicated cystitis due to highest susceptibility and least resistance • The newer formulation of nitrofurantoin (Nitrofurantoin monohydrate/macrocrystals) offers the advantage of better GI tolerability and BID dosing, which improves the compliance
  • 84. Highlights • One year prophylaxis with nitrofurantoin significantly reduces the no of symptomatic episodes • The antimicrobials used for prophylaxis are: Fluoroquinolones, nitrofurantoin,TMP/SMX, cephalosporins etc. • Recurrent UTI can be managed by offerring long term prophylaxis or post coital prophylaxis • A major concern in the treatment of UTI is recurrence and one in four women will develop recurrence
  • 85. Highlights • Fluroquinolones may be considered for empiric therapy of complicated UTI due to their broad spectrum antibacterial activity and good tissue penetration • The treatment duration for the symptomatic UTI in pregnant women should be 10-14 days • Asymptomatic bacteriuria in pregnant women should be treated • The choice of antimicrobials in diabetic patients is similar to non diabetics but the duration should be 10-14 days
  • 86. THANK YOU