urinary tract infection introduction, antibiotic available fro treatment and prophylaxis for the same.

1. URINARY TRACT
INFECTION
PRESENTED BY :
Arun Agarwal
B.PHARM (2011-2015)
Invertis institute of pharmacy, invertis university, bareilly

2. CONTENTS
 INTRODUCTION
 HOST DEFENCE MECHANISMS
 EPIDEMIOLOGY
 ETIOLOGY
 RISK FACTORS
 PATHOGENESIS
 CLINICAL MANIFESTATION
 MANAGEMENT
 TREATMENT OF SYMPTOMATIC UTI
 PROPHYLAXIS OF UTI

3. INTRODUCTION
 The term urinary tract infection (UTI) usually refers to the presence of
organisms in the urinary tract together with symptoms, and sometimes
sign of inflammation.
 One third of the hospital –acquired infections
 E.coli is the most frequent pathogens with account of about one-third of
community- acquired UTI.
 These can be called as asymptomatic or symptomatic which depends on
the infection.

4. HOST DEFENCE MECHANISMS

5. EPIDEMIOLOGY
 In infants upto the age of 6 months symptomatic UTI has a prevalence of
about two cases per 1000.
 In children The prevalence of becteriuria is 4.5% in girls and 0.5% in boys.
 When a women reach adulthood, the prevelence of becteriuria rises to
between 3% and 5%. UTI In men rises progressively with age, from 1% to
4% at age 60.
 In the elderly of both sexes the prevalence of becteriuria rises dramatically,
reaching 20% among women and 10% among men.

6. ETIOLOGY
 Escherichia coli is most common causative agents, responsible for about
80% of infections.
 The remaining 20% are caused by other gram negative enteric bacteria
such as Klebsiella and Proteus species and gram positive cocci such as
Enterococci and Stephylococcus suprophyticus.
 Rare causes of urinary infection, nearly always in association with
structural abnormalities or catheterization.

7. RISK FACTORS

8. PATHOGENESIS

9. CLINICAL MANIFESTATION
 Urine dipstick test showing positive nitrites or leukocyte esterase are
suggestive of UTI.
 Nitrite: positive due to bacterial reduction of endogenous nitrates to
nitrites; classically positive in Gram-negative Enterobacteriaceae family of
enteric uropathogens. However, nitrite dipstick may also be clinically
useful in detecting Enterococcus and Staphylococcus bacteria.
 Leukocyte esterase: presence of neutrophils in urine due to inflammation
and leukocyte migration into the urinary tract.

10. MANAGEMENT
 Symptomatic UTI- antibiotic therapy
 Asymptomatic UTI- no treatment required except in special situations.
 Non- specific therapy:
1. more water intake.
2. Maintaining acidity of urine by fluids like canberry juice.

11. TREATMENT OF SYMPTOMATIC UTI
 Trimethoprim-sulfamethoxazole
Inhibition of microbial DNA synthesis by inhibiting the folic acid
synthesis and consequently the purines required for DNA
 Fluoroquinolones
Inhibition of microbial DNA synthesis by blocking DNA gyrase and
topoisomerase IV needed for successful DNA replication and transcription.
 Nitrofurantoin
The mechanism is not fully understood, but it directly causes
selective damage to microbial DNA, which metabolises the toxic
intermediates of nitrofurantoin more rapidly than human cells.

12. ANTIBIOTIC
TREATMENT

13. ANTIBIOTIC TREATMENT

14. PATHOGEN SPECIFIC TREATMENT
Pathogen Treatment options
Escherichia coli Ceftriaxone 50mg/kg i.v /I.M Qday
Pseudomonas aeroginosa Gentamycin 6-7.5mg /kg
i.v Q8hr / Qday
Klebsiella sps
Enterobacter sps
Proteus sps
Ceftadizine 100-150mg/kg/day i.v Q8hr
Enterococcus sps Ampicillin 100-200mg/kg/day Q6hr

15. PROPHYLAXIS OF UTI
Cranberry juice:
 Cranberry juice (Vaccinium macrocarpen) has long been thought to be benificial
in preventing UTI, and this has been studied in a number of clinical trials.
 In sexually active women intake of 750ml cranberry juice was associated with a
40% reduction in the risk of symptomatic UTI .
 It is also reduce the risk of development of antibiotic resistant bacteria.

16. Antibiotic treatment:
 Mainly women, reinfection are so frequent that long term antimicrobial prophylaxis
with specific antibiotics is indicated.
 If the reinfection is clearly related to sexual intercourse, then a single dose of an
antibiotic after intercourse is appropriate.
 Long term low dose prophylaxis may be beneficial.

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