Treatment of Urinary tract infection

1. Management Of UTI

2. Introduction
• Symptomatic presence of micro organisms
within the urinary tract
i.e., kidney, ureters, bladder and urethra.
• Associated with inflammation of urinary tract.

3. • Significant bacteriuria: presence of at least
105
CFU/ml of urine.
• Asymptomatic bacteriuria : bacteriuria with
No symptoms.
• Urethritis: infection of anterior urethral tract
dysuria, urgency and frequency of urination.
• Cystitis: infection to urinary bladder
dysuria, frequency and urgency, pyuria and
haematuria.

4. • Acute pyelonephritis: infection of one/both
kidneys; characteristically Fever and flank
pain
• Chronic pyelonephritis: particular type of
pathology of kidney; may/may not be due to
infection.

5. Epidemiology
 Women – at greater risk than men;
prevalence 40-50%in women and 0.04% in
men.
 10% women have recurrent UTI in their life
 Incidence of UTI increases in old age;
incidence similar in men & women.

6. Etiology
• Acute uncomplicated UTI:
• Escherichia coli – cause about 80% of UTI
• 20% of UTI caused by-
Gram negative enteric bacteria – Klebsiella,Proteus
Gram positive cocci – Streptococcus faecalis
Staphylococcus saprophyticus
• S.saprophyticus – restricted to infections in young
sexually active women.

7. UTI – RISK FACTORS
1. Aging: Diabetes mellitus
Incomplete bladder emptying
Impaired immune system
2. Females: shorter urethra
sexual intercourse
3. Males: prostatic hypertrophy
age

8. Clinical manifestations depending on site of
infection
• Urethritis:
 Discomfort in voiding
 Dysuria
 Urgency
 frequency

9. t
 Cystitis:
 dysuria, urgency and frequent urination
 Abdominal pain (Suprapubic)
 Pyuria
 Hemorrhagic cystitis:
 Visible blood in urine.
 Irritating voiding symptoms
 Pyelonephritis
o Fever
o Flank Pain
o Systemic symptoms

10. UTI- DIAGNOSIS
• Microscopic examination of urine
• Urinalysis
• Urine culture
• Imaging techniques – CT scan and MRI

11. UTI - management
• Symptomatic UTI- antibiotic therapy
• Asymptomatic bacteriuria- no treatment required except in
special situations.
• Non- specific therapy:
• More water intake.
• Maintaining acidity of urine by fluids like cranberry
juice.
• Phenazopyridine (analgesic)

12. Acute uncomplicated Lower
UTI
1st LINE:
 Nitrofurantoin 100 mg twice daily for 7 days
 Cotrimoxazole 1 DS(160/480 mg) twice daily 3-5 days
 Fosfomycin 3g single dose
 Pivmecillinam
2nd LINE
 Fluoroquinolones
 Amoxicillin-clavulanate

13. Complicated Cystitis
1st LINE
 Oral or parenteral FQs for longer duration (10-14 days)
 Other agents: Ampicillin, Piperacillin-tazobactam,
Imipenem-cilastatin
 Switch to oral therapy once clinically improved

14. Acute Pyelonephritis
 Parenteral antibiotic followed by oral therapy for 10-14
days
Drugs:
 Nitrofurantoin not used
 Ciprofloxacin or levofloxacin
 FQ resistance, Ceftriaxone or gentamicin and co-
amoxiclav, carbapenems

15. Severe complicated UTI (Sepsis/ICU pts)
 ESBL producing organisms/Pseudomonas/MRSA :
Carbapenems plus Vancomycin
 Meropenem-vaborbactam

16. UTI in Pregnancy
 DOC ampicillin or cephalosporins
 ASB should be treated for 4-7 days
 Pyelonephritis: Parenteral Beta-lactams
 FQs avoided

17. UTI in Men
 Acute bacterial prostatitis: FQs or cotrimoxazole for 2-
4 weeks
 Chronic bacterial prostatitis: 4-6 Weeks
 Recurrence- 12 week course.

18. Prophylaxis for UTI
 Recurrent cystitis
 Catheterisation
 Anatomical defects
 Inoperable prostatic enlargement
Drugs used:
Cotrimoxazole 480 mg
Nitrofurantoin 100 mg
Cephalexin 250 mg
Either of them once daily for 6 months.

19. Antibiotics used in treatment

20. Sulfamethoxazole-trimethoprim
 Adverse effects:
o Steven Johnson's syndrome
o Dermatitis
o Angiodema
o GI disturbances
o Agranulocytosis
 Contraindicated in
o Hypersensitivity to sulfa
drugs
o Infants
o Megaloblastic anaemia
Mechanism of action

21. Nitrofurantoin
 Damages bacterial DNA.
 Reduced to reactive forms by bacterial
nitroreductase- damage DNA, ribosomes
 Adverse effects:
Hypersensitivity pneumonitis, hemolytic
anemia
 Contraindications:
Renal failure, neonates, pregnancy

22. Amoxicillin
 Beta-lactam antibiotic
 Inhibits cross linking of peptidoglycan polymer chains
which is the major component of bacterial cell wall.
 Adverse effects:
o Rash
o Antibiotic associated colitis
 Contraindications: penicillin
hypersensitivity

23. Ciprofloxacin
 Fluoroquinolone antibiotic
 Inhibits DNA gyrase and topoisomerase IV, the enzymes
necessary for separation of bacterial DNA – inhibit cell
division
 Adverse effects:
o CNS: Impairment of concentration, tremors, seizures (rare)
o Tendinitis and tendon rupture rarely
o FDA issued warning of hypoglycemia

24. THANK YOU