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
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
General loss of health
Pus cells (+)
Infection localized to
urethra and bladder.
dysuria, pain in perineum.
+/- fever, chills,
Pus cells (+++)
Urine culture (+)–
Urethritis- painful urination
Cloudiness in urine
Blood in urine
Micro organism counts:
1000/ml of one type
100/ml of E.coli
Cystitis- inflammation of the
bladder, but known to
patients as any UTI.
Infection caused by
bacterial infection mainly E.
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
Acute infection of the
kidneys caused by
fever, loin pain,
increase in WBC, and
kidney function and
require IV antibiotics
caused by chronic
inflammation of renal and
tubular tissue with scarring
and shrinkage secondary
95% of UTI are due to gram –ve bacilli.
-80% E.coli (commonest)
5% of UTI are due to gram +ve cocci
Mixed infections are likely to be present in
chronic cases, in diabetics, obstructive
uropathies, indwelling catheters
Bacteriological examination of mid
Diabetes mellitus must be ruled out.
Men with UTI often have obstructive
lesions or a focus of infection in the
Effective against E.coli
Ineffective in-chronic, complicated
cases or mixed infections
Cheap, easily available, and effective
Bacterial resistance major problem.
DOC: Sulfisoxazole 2g initially 1g qid for
Prerequisite-Alkaline urine, liberal fluid
Rapid g.i. absorption, high urinary
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
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
Ineffective in renal insufficiency.
Effective bactericidal to E.coli ,aerobacter.
Proteus, pseudomonas resistant.
Ineffective against penicillinase producing
Safe in pregnancy
Dose:.0.5 g qid x 7-10 days.
Resistant strains of E.coli esp.. hospital
acquired has been found.
Useful in pseudomonas infection of urinary
Infection when combined with Gentamicin.
-Broad spectrum activity against g-ve org.
-Dose:4-8 g iv daily in divided doses.
Status – use should be limited to severe life
Gentamicin is the only aminoglycoside
used in UTI.
Effective against E.coli,proteus,pseudo.
Disadv.- parental use
Reserved for complicated UTI
Ideal agents and drug of choice.
Useful in nosocomial pylonephritis,
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
4. Drug may be cidal /static –former more
5. Doses should be adequate for adequate
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.
7-14 days treatment :
Failure of 3 day regimen
Recurrence both in men & women
Patients with renal disease
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 /
2.Complicated UTI :
Minimal symptoms- Cipro. 500mg bd
Severe illness :
(Inj. Cefotaxime 2g qid iv & Inj.Genta 5 mg/kg od iv) x7-14 days
3.Chronic Pylonephritis : choice of drug after AST
cause to be searched.