Urinary Tract Infection


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Urinary Tract Infection

  1. 1.  UTIs are defined by the presence of micro organisms within the urinary tract  Difficult to distinguish between contamination, colonization or infection
  2. 2. 150 million people per year become infected 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 for UTIs.
  3. 3. CHRONIC  General loss of health anaemia,hypertension.  Chronic Pylonephritis- Chronic hypertension &renal failure.  Pus cells (+)  Significant bacteriuria ACUTE  Infection localized to urethra and bladder.  frequency, urgency, dysuria, pain in perineum.  +/- fever, chills, leucocytosis  Pus cells (+++)  Urine culture (+)– “significant bactertiuria”
  4. 4.  Urethritis- painful urination and burning  Cloudiness in urine  Blood in urine  Micro organism counts: 100,000/ml (traditional) 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. coli.  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 found.
  5. 5.  Pyelonephritis-  Acute infection of the kidneys caused by progressively untreated cystitis  Symptoms include fever, loin pain, increase in WBC, and bacteraemia  Can compromise kidney function and require IV antibiotics  Chronic pyelonephritis- caused by chronic inflammation of renal and tubular tissue with scarring and shrinkage secondary interstitial fibrosis.
  6. 6. Rectum vaginal intoritus Bacteria Urethra Bladder
  7. 7.  95% of UTI are due to gram –ve bacilli. -80% E.coli (commonest) -15% Proteus Klebsiella Pseudomonas  5% of UTI are due to gram +ve cocci Enterococci Staphylococci Streptococci  Mixed infections are likely to be present in chronic cases, in diabetics, obstructive uropathies, indwelling catheters
  8. 8.  Bacteriological examination of mid stream urine.  Diabetes mellitus must be ruled out.  Men with UTI often have obstructive lesions or a focus of infection in the prostrate.
  9. 9.  BACTERIOSTATIC AGENT Sulfonamides Tetracycline Nitrofurantoin  URINARY ANTISEPTICS Nalidixic acid Methenamine mandelate Nitrofurantoin  BACTERICIDAL AGENTS Cotrimoxazole Ampicillin Extended spect. Penicillin Aminoglycosides Fluroquinolones Cephalosporins
  10. 10.  Effective against E.coli  Ineffective in-chronic, complicated cases or mixed infections  Cheap, easily available, and effective orally.  Bacterial resistance major problem.  DOC: Sulfisoxazole 2g initially 1g qid for 7-10 days  Prerequisite-Alkaline urine, liberal fluid intake.
  11. 11.  Rapid g.i. absorption, high urinary concentration.  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 obstructive uropathy.
  12. 12.  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
  13. 13.  Used as reserved drug for occasional cases (esp. proteus resistant to other drugs)  Dose: 1gm qid x 7-10 days
  14. 14.  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 (prostatic focus)  Ineffective in renal insufficiency.
  15. 15.  Effective bactericidal to E.coli ,aerobacter.  Proteus, pseudomonas resistant.  Ineffective against penicillinase producing staph. aureus.  Safe in pregnancy  Dose:.0.5 g qid x 7-10 days.  Resistant strains of E.coli esp.. hospital acquired has been found.
  16. 16.  CARBENICILLIN: Useful in pseudomonas infection of urinary Infection when combined with Gentamicin.  PIPERACILLIN: -Broad spectrum activity against g-ve org. (pseudomonas areuginosa). -Dose:4-8 g iv daily in divided doses. Status – use should be limited to severe life threatening infections.
  17. 17.  Gentamicin is the only aminoglycoside used in UTI.  Effective against E.coli,proteus,pseudo.  Disadv.- parental use renal toxicity ototoxicity  Reserved for complicated UTI
  18. 18.  Ideal agents and drug of choice.  Useful in nosocomial pylonephritis, complicated UTI.  Present status: first line drug for all UTI.
  19. 19.  Valuable in infections resistant to other antibiotics (E.coli, Proteus,Pseudomonas)  Doc. –Klebsiella infections.  Indicated in septicemic UTI.
  20. 20. 1. Acute cases treatment immediate. 2. Chronic case treatment after investigations. 3. Drug must achieve adequate conc. In tissue and lumen. 4. Drug may be cidal /static –former more capable.
  21. 21. 5. Doses should be adequate for adequate period. 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.
  22. 22. 1.Acute complicated cystitis: 3 day regimen Cotrimoxazole : 2 tab bd Ampicillin : 250-500mg qid Cephalexin :500mg qid Trimethoprin :100mg bd Norflox : 400mg bd Ciproflox : 250mg bd
  23. 23.  7-14 days treatment : Indications: Failure of 3 day regimen Symptomatic men Recurrence both in men & women Pregnant women Children Patients with renal disease
  24. 24. 2.Cystitis : 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
  25. 25. 1.Acute uncomplicated pylonephritis: Drug regimen : Cotrimoxazole /Gentamicin with/ without Ampicillin / Cephalosporins 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.