Uti -for_non-urologists-uncomplicated and complicated

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Uti -for_non-urologists-uncomplicated and complicated

  1. 1. Urinary Tract Infection
  2. 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. 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. 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. 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. 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. 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. 8. Routes of Infection Common route – Ascending through urethra Other route – Blood and lymphatic EAU Guidelines 2006
  9. 9. UTI Community acquired UTI Nosocomial UTI UTI - Classification EAU Guidelines 2006
  10. 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. 11. Site of origin Epididymitis Prostatitis Pyelonephritis Cystitis Urethritis UTI - Classification Orchitis EAU Guidelines 2006
  12. 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. 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. 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. 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. 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. 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. 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. 19. Diagnosis Urine Analysis -Dipstick method • Nitrite • Leukocyte esterase - Microscopic analysis • Bacteriuria • Pyuria • Hematuria EAU Guidelines 2006
  20. 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. 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. 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. 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. 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. 25. Choice of antibiotics should take into account not only the spectrum of activity but also resistance
  26. 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. 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. 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. 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. 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. 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. 32. Follow-up Urine Analysis - Bacteriuria Urine culture - If symptoms do not resolve or recur within 2 weeks EAU Guidelines 2006
  33. 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. 34. Prophylaxis for Recurrent UTI Pharmacological - Antibiotic prophylaxis Non Pharmacological - Voiding after intercourse - Cranberry juice - Alkalizer (Potassium citrate) EAU Guidelines 2006
  35. 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. 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. 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. 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. 39. Nitrofurantoin has maintained its place in the treatment of UTI due to least resistance
  40. 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. 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. 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. 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. 44. Complicated UTI • Pregnancy • Diabetes • Paediatric UTI • Catheter associated urinary tract infection (CAUTI) • Prostatitis
  45. 45. UTI in PregnancyUTI in Pregnancy
  46. 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. 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. 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. 49. UTI in DiabetesUTI in Diabetes
  50. 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. 51. Diabetes Causative organisms E.Coli - 75% Klebsiella Enterobacter S.faecalis Fungi Int J Anti Agents 2008;31S:S54-S57
  52. 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. 53. Paediatric UTIPaediatric UTI
  54. 54. UTI in Children
  55. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 65. Catheter Associated Urinary Tract Infections (CAUTI)
  66. 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. 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. 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. 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. 70. BIOFILM FORMATION PLANKTONIC BACTERIA ATTACHMENT MICROCOLONIES BIOFILM COMMUNITY Arch Intern Med / Vol.164,Apr 26,2004
  71. 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. 72.  The duration of catheterisation should be minimal  Prophylactic antibiotics and Chronic antibiotic suppressive therapy is generally not recommended PreventionPrevention EAU Guidelines 2010
  73. 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. 74. ProstatitisProstatitis
  75. 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. 76. Diagnosis: Quantitative segmental bacterialDiagnosis: Quantitative segmental bacterial localization culture (Meares and Stamey)localization culture (Meares and Stamey)
  77. 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. 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. 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. 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. 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. 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. 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. 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. 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. 86. THANK YOU

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