This document discusses the pharmacotherapy of urinary tract infections and provides information on chloramphenicol and tetracyclines. It covers the epidemiology, pathogenesis, definitions, and drug therapy for UTIs. Common causative organisms are E. coli and other gram-negative bacteria. Drug choices depend on the site and severity of infection. For uncomplicated lower UTIs, short 3-day courses of antibiotics like TMP-SMX are often used. More severe infections involving the kidneys may require parenteral antibiotics in hospital. The document also discusses UTI in specific groups like children, pregnant women, and those with structural abnormalities.
Pharmacology of antimalarial drugs with treatment of malaria. mechanism of action, uses, adverse effects of antimalarial drugs like chloroquine, quinine, artemisinin compounds.
Pharmacology of antimalarial drugs with treatment of malaria. mechanism of action, uses, adverse effects of antimalarial drugs like chloroquine, quinine, artemisinin compounds.
Detailed information of all terms like Thyroid gland, Thyroxine, Triidothyronine, Calcitonine, growth and development , propylthiouracil, Calorigenesis, tadpole to frog, Oligomenorrhoea, snehal chakorkar, pharmacology, Cretinism, Myxoedema coma, Graves disease, Thiocynates, Perchlorate, Nitrates.
Radioactive iodine, I131
Anthelmintics | B.Pharm 3rd year 2nd Sem | Medicinal Chemistry-III | History, Classification, Structures & Synthesis of anthelmintics, Synthesis of Diethylcarbamazine citrate, Synthesis of Mebendazole
Detailed information of all terms like Thyroid gland, Thyroxine, Triidothyronine, Calcitonine, growth and development , propylthiouracil, Calorigenesis, tadpole to frog, Oligomenorrhoea, snehal chakorkar, pharmacology, Cretinism, Myxoedema coma, Graves disease, Thiocynates, Perchlorate, Nitrates.
Radioactive iodine, I131
Anthelmintics | B.Pharm 3rd year 2nd Sem | Medicinal Chemistry-III | History, Classification, Structures & Synthesis of anthelmintics, Synthesis of Diethylcarbamazine citrate, Synthesis of Mebendazole
Pharmaceutical Industry presentation.pptxyourkelpy
A pharmaceutical presentation is a formal communication or demonstration that conveys information related to the pharmaceutical industry. These presentations are often delivered in various settings, including conferences, seminars, board meetings, or sales pitches. The purpose of a pharmaceutical presentation can vary, but it typically involves educating, informing, or persuading the audience about a particular aspect of the pharmaceutical field.
Discuss ongoing or recent research projects.
Showcase innovative approaches, technologies, or methodologies.
Highlight any breakthroughs or advancements in drug development.
Remember to tailor the content of the presentation to the specific audience and the purpose of the presentation, whether it's to inform stakeholders, attract investors, or educate healthcare professionals. Visual aids such as slides, charts, and graphs can enhance the presentation and make complex information more digestible for the audience.
• Tuberculosis (TB) is an infectious disease usually caused by the bacterium Mycobacterium tuberculosis (MTB).
• Tuberculosis generally affects the lungs, but can also affect other parts of the body.
• Most infections do not have symptoms, in which case it is known as latent tuberculosis. About 10% of latent infections progress to active disease, which, if left untreated, kills about half of those infected.
• The classic symptoms of active TB are a chronic cough with blood-containing sputum, fever, night sweats, and weight loss.
• The historical term "consumption" came about due to the weight loss. Infection of other organs can cause a wide range of symptoms.
• Tuberculosis is spread through the air when people who have active TB in their lungs cough, spit, speak, or sneeze. People with latent TB do not spread the disease. Active infection occurs more often in people with HIV/AIDS and in those who smoke.
A urinary tract infection (UTI) is an infection in any part of your urinary system _your kidneys, ureters, bladder and urethra.
Most infections involve the lower urinary tract- the bladder and the urethra.
Women are at greater risk of developing a UTI than are men.
Among adults aged 20 to 50 years , UTIS are about 50- fold more common in women.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
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Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
3. INTRODUCTION
Common disorder
Normal urinary tract is generally resistant to
infection.
Female urinary tract is more susceptible to
infection.
4. CONTD..
50% of patients, a predisposing cause cannot be
demonstrated.
In recurrent UTI, it is essential to look for
predisposing causes.
UTI may present itself as
Acute infection
Chronic infection
5. ACUTE INFECTION
Two general anatomical categories
1. Lower tract infection : uretheritis and cystitis
2. Upper tract infection : Acute pyelonephritis,
prostatitis, intrarenal and perirenal abscesses.
6. CONTD..
Lower UTI Upper UTI
Increased frequency and urgency
of micturation, dysuria and pain in
the perineum
Loin pain, fever, chills and
leucocytosis.
Fever ,chills and leucocytosis are
generally absent.
Urine with pus cells, urine culture
is positive and shows significant
bacteriuria.
Infection is considered superficial
or mucosal infection
Infection is tissue invasion.
7. CHRONIC INFECTION
Polyuria and nocturnal frequency may be present.
General loss of health and weight, anaemia and
hypertension are also present
Chronic pyelonephritis is an important cause of
hypertension and chronic renal failure.
8. EPIDEMIOLOGY
Subdivided into catheter-associated (nosocomial)
and non catheter-associated (community acquired)
infection.
Acute community acquired UTIs are very common.
In women
In 1-3% of school girls
Then increased markedly with onset of sexual activity.
9. CONTD..
In men
First year of life
Unusual under 50 year age.
Asymptomatic bacteriuria is 50% but uncommon
among men under 50 year and common among
women in 20-50 year age group.
Asympatomatic bacteriuria is more common among
elderly men and women with rates as high as 40-
50% in some studies.
12. CONDITIONS AFFECTING THE PATHOGENESIS
Gender and sexual activity
Pregnancy
Obstruction
Neurogenic bladder dysfunction
Vesicoureteral reflux
Bacterial virulence factors
13. CATHETER ASSOCIATED UTIS
Bacteriuria develops in 10-15% of hospitalised
patients with short term indwelling urethral
catheters.
Risk of infection is 3-5% per day of catheterization
E.coli, proteus, pseudomonas, klebsiella, serratia,
staphylococci, enterococci and candida usually
cause these infection.
14. CONTD..
Infection occurs when bacteria reach the bladder by
one of two routes
1. Migration through the column of urine in the
catheter lumen( intraluminal route)
2. Up the mucous sheath outside the
catheter(periuretheral route)
16. CONTD..
In patients catheterized for <2 weeks, catheter-
associated UTIs can be prevented by use
Of a sterile closed collecting system
Aseptic technique
Short course of systemic antimicrobial therapy
Application of periuretheral antimicrobial ointments
17. DEFINITIONS
Significant bacteriuria
Colony count > 105 /ml of single species in a midstream
clean catch sample.
Asymptomatic bacteriuria
Significant bacteriuria in absence of symptoms of urinary
tract infection
18. CONTD..
Simple UTI
UTI with low grade fever, dysuria, frequency and
urgency and absence of symptoms of complicated UTI.
Complicated UTI
Presence of fever>39ºc, systemic toxicity, persistent
vomiting, dehydration, renal angle tenderness and
raised creatinine
Recurrent infection
Second episode of UTI
19. DIAGNOSIS
Clinical features and history
Microscopic examination of urine
Dipstick tests
Culture and sensitivity
20. BACTERIAL COUNTS ARE CLINICALLY RELEVANT IN A
SAMPLE OF MID STREAM URINE (MSU)IF:
> 103 CFUs/mL in acute uncomplicated cystitis in a
woman
> 104 CFUs/mL in acute uncomplicated
pyelonephritis in a woman
> 105 CFUs/mL, or > 104 CFUs/mL of MSU in a
man or in straight catheter urine in women in a
complicated UTI.
In a suprapubic bladder puncture specimen, any
count of bacteria is relevant
21. DRUG THERAPY OF UTIS
Goals for treatment of UTI
1. Symptomatic relief by altering pH of urine
2. Eradication of infecting organisms
3. Prevention and treatment of recurrence
4. Identification and treatment of predisposing
factors
22. GENERAL PRINCIPLES
In acute cases, an appropriate drug may be started
as soon as urine has been collected for
bacteriological examination.
In chronic cases, mixed infection is more likely and
concomitant renal failure may modify drug therapy.
In such cases, there is no desperate hurry to start
drug treatment before case is thoroughly
investigated.
23. CONTD..
Drug must be used in adequate doses and for
adequate periods.
Growth of E.coli is optimum at pH 6 to 7 and is
inhibited at pH below 5.5 and above 7.5.
pH of urine must also be maintained at a level that
would permit optimum antibacterial activity of drug
used.
24. CONTD..
Fluid intake should be liberal as frequent emptying
of bladder helps
To reduce bacterial count in urine and as growth of
E.Coli is reduced of urine is very dilute
There is no satisfactory antibacterial drug to which
all the strains of E.coli are invariably sensitive.
26. SULFONAMIDES
Bacteriostatic
Most common drug used in E. coli infection
Effective urine and tissue levels
Development of bacterial resistance is a major
problem
27. COTRIMOXAZOLE
Potent and cost effective bactericidal agent against
many common urinary tract pathogens.
In acute uncomplicated UTI, it is used in dose of 2
tablets BID for 7-10 days.
In small dose effective in eliminating chronic
bacteriuria.
Trimethoprim concentrates in prostate.
28. AMPICILLIN
Orally and parentally, Bactericidal.
Good tissue levels and is excreted unchanged in
urine in high concentration.
Dose of 0.5 g six hourly for 7-10 days.
Useful for the treatment of UTI in pregnant women
Hospital acquired infection are resistant
30. PIPERACILLIN
Broad spectrum activity against gram negative
organism especially Pseudomonas Aeruginosa.
For moderate infection 4-8 gms/ day I.V.
For life threatening infection 12-16 gms/day
Its use should be limited to severe UTIs with life
threatening septicemia
31. AMINOGLYCOSIDE ANTIBIOTICS
Gentamicin and amikacin.
Effective against E.coli, proteus and pseudomonas.
Given parentally, Can cause ototoxicity and renal
toxicity.
Single daily dose can reduce renal toxicity,
reserved for complicated UTIs
32. FLUROQUINOLONES
Ideal agents for nosocomial pyelonephritis and
complicated UTIs.
Norfloxacin, ciprofloxacin, ofloxacin, pefloxacin and
lomefloxacin.
Highly effective orally.
Effective against bacteria resistant to beta-lactam
and aminoglycoside antibiotics.
33. CEPHALOSPORINS
Used in infection with E.coli and proteus resistant to
other antibiotics.
DOC for klebsiella infection.
3rd generation cephalosporins are effective against
multi-drug resistant enterobacteria and
pseudomonas.
Septicemic UTI.
34. FOSFOMYCIN
It is bactericidal against a range of gram-positive
and gram negative bacteria.
A single 3g oral dose is used to treat uncomplicated
UTIs in women.
Antibiotic fosfomycin may be prescribed as a single
dose treatment for women who are pregnant.
35. NITROFURANTOIN
Rapidly absorbed from GIT.
Urine concentration high but poor tissue
concentration.
Unsuitable for renal parenchymal diseases.
36. CONTD..
Used in chronic suppressive therapy in a dose of
50-100 mg/day for several weeks.
Single indication of nitrofurantoin is treatment as
well as long term prophylaxis of lower UTIs mainly
E. coli.
Safe in pregnancy.
37. NALIDIXIC ACID
0.5 g Tablets.
Dose is 4 gms /day in 4 divided dose for 7-10 days.
Reserved for occasional cases with infection with
Proteus
38. METHANAMINE MANDELATE
Salt of mandelic acid and methenamine.
Rapidly absorbed from GIT, excreted in urine.
At acidic pH less than 5.5, methenamine liberates
formaldehyde.
Dose is 500mg q.i.d.
39. CONTD..
Mandelic acid helps to lower urine pH.
Not active against acute infection but used in
chronic suppressive therapy.
Larger doses cause acute inflammation.
40. PHENAZOPYRIDINE
It is dye exerts analgesic effects in UTIs
Provides relieve from burning sensation, dysuria
and urgency due to cystitis.
Devoid of antibacterial activity.
Dose 200mg TDS orally.
41. CHOICE OF ANTIBACTERIAL THERAPY OF UTI
IS DETERMINED BY
Site of infection in urinary tract.
Whether a predisposing cause such as diabetes or
abnormality of urinary tract is absent
uncomplicated UTI or present complicated UTI.
Whether infection is caused by drug sensitive or
drug resistant organism.
43. UNCOMPLICATED CYSTITIS IN WOMEN
Women with diabetes, symptoms for >7days, recent
UTI, use of diaphragm, age >65 years, pregnancy
7 day regimen orally
• Amoxicillin 250 mg 8 hourly
• Cefpodoxime proxetil 100 mg 12 hourly
• TMP-SMX 160/800 mg 12 hourly
44. ACUTE UNCOMPLICATED PYELONEPHRITIS
In women most cases without associated clinical
evidence of calculi or urological disease
Mild to moderate illness, no nausea or vomiting
Oral quinolone for 7-14 day ( initial dose given I.V., if
desired), Single dose ceftriaxone 1g, Gentamicin 3-5
mg/kg, followed by oral TMP-SMX for 14 days
45. CONTD..
In cases of severe illness or possible urosepsis:
hospitalisation required.
Parenteral quinolone, gentamicin 1mg/kg 8 hourly,
ceftriaxone 1-2g/day until subside of fever.
Oral quinolone, cephalosporin, or TMP-SMX for 14
days.
47. COMPLICATED UTIS
In mild to moderate illness, oral quinolone for 10-14
days until culture results and antibiotic sensitivities
are known.
In severe cases, parenteral therapy should be
started.
Parenteral Oral
Ampicillin 1g 6 hourly and
gentamicin 1mg/kg 8 hourly
Quinolones
Quinolone TMP-SMX
Ceftriaxone 1-2g/day
Ticarcillin/clavulanate 3.2 g 8
hourly
Imipenem/cilastatin 250-500 mg
8 hourly
48. POSTCOITAL CYSTITIS
Some women get lower UTI following every sexual
intercourse.
Initial treatment by suitable antibacterial drug.
Followed by 0.5% cetrimide cream in periurethral
area before coitus and bladder emptying after every
sexual act.
This may be followed by single dose Ampicillin or
TMP-SMX.
49. ASYMPTOMATIC BACTERIURIA
Transient and resolves without treatment
Removal of catheter followed by short course of
antibiotics
If catheter can not be removed then use of systemic
antibiotic when symptoms appear
51. UTI IN CHILDREN
Mostly first 3 months, UTI is more common in boys
3.7% than in girls (2%),
After which incidence changes, being 3% in girls
and 1.1% in boys.
Paediatric UTI is most common cause of fever of
unknown origin in boys less than 3 years.
52. CONTD..
The clinical presentation of a UTI in infants and
young children can vary from fever to
gastrointestinal, lower or upper urinary tract
symptoms.
Investigation should be undertaken after two
episodes of a UTI in girls and one in boys.
53. CRITERIA FOR DIAGNOSIS OF UTI
Urine specimen from suprapubic aspiration
Any number of CFU/mL
Urine specimen from bladder puncture
catheterization
> 1,000-50,000 CFU/mL
Midstream clean catch
> 104 CFU/mL with symptoms
> 105 CFU/mL without Symptoms
55. VESICOURETERIC REFLUX (VUR)
40-50% of infants and 30-40% chidren with UTI and
resolves with age.
Its severity graded from I to V based on
appearance of urinary tract on micturating
cystourethrogram.
Grade I-III are more likely to resolve.
56. UTI DUE TO CANDIDA
Usually occurs with urinary catheters, typically after
antibiotic therapy
At high risk are patients who are
immunocompromised because of tumor, AIDS,
chemotherapy.
Asymptomatic candiduria rarely requires therapy.
57. CONTD..
Candiduria should be treated in the following:
Symptomatic patients
Neutropenic patients
Patients with renal allografts or
Patients who are undergoing urologic manipulation
58. TREATMENT
Catheters should be removed.
Treatment with fluconazole 200 mg once/day for 7
to 14 days.
I.V. amphotericin B.
Bladder irrigation with amphotericin B.
59. ANTIMICROBIAL PROPHYLAXIS
Indications
Women of child bearing group.
Catheterization or instrumentation inflicting trauma
Uncorrectable congenital anamolies.
Inoperable prostate enlargement or chronic obstruction.
60. CONTD..
Drugs used for prophylaxis are
All drugs are given once daily at bed time.
Cotrimoxazole 480mg
Nitrofurantoin 100mg
Norfloxacin 400mg
Cephalexin 250mg
61. CHLORAMPHENICOL
Broad spectrum antibiotic – Bacteriostatic
Inhibits protein synthesis – binds to 50S ribosome
subunit – causes inhibition of peptidyl transferase
Undergoes enterohepatic circulation – inactivated
by hepatic glucuronidation
Very few systemic use – due to
Rapid development of resistance
High toxicity
63. TETRACYCLINES
Binds to 30S ribosomal subunit – inhibits
binding of aminoacyl- t RNA to A site
Group I – tetracycline , chlortetracycline
, oxytetracycline
Group II – demeclocycline , lymecycline
Group III – doxcycline, minocycline
64. Pharmacokinetics –
Oral absorption – impaired by food and multivalent
cations
Cross placenta - affect fetus
Undergo enterohepatic circulation
Excreted primarily in urine except doxycycline
Doxcycline – excreted in feces
66. Toxicity –
1. Superinfection diarrhoea & pseudomembranous
colitis
2. Gastrointestinal side effects – most common
adverse effects
3. In Young children ( < 8 yrs ) – may cause dentition
abnormalities
4. Contraindicated – in pregnancy
Fetal tooth enamel dysplasia
Irregularities in fetal bone growth
5. Outdated tetracycline – fanconi’s syndrome
67.
68. FINAFLOXACIN
Phase III trials
Marked increase at acidic pH
Very high safety profile and wide spectrum.
Longer t1/2 supportive of once daily dosing.
69. TETRACYCLINE
Doxycycline, tetracycline, and minocycline.
Used for infections that are caused
by Mycoplasma or Chlamydia.
They cannot be taken by children or pregnant
women.
70. CONTD..
Many infecting strains marked broader antimicrobial
resistance.
Factors associated with an increase risk of
catheter-associated UTI include female sex,
prolonged catheterization, severe underlying
illness, disconnection of the catheter and drainage
tube, faulty catheter care and lack of systemic
antimicrobial therapy.
71. MANAGEMENT OF VUR
VUR grade Management
Grades I and II Antibiotic prophylaxis until 1 year
old. Restart antibiotic up to 5 yr of
age if breakthrough febrile UTI.
Grade III to V Antibiotic prophylaxis up to 5 year
of age. Consider surgery if
breakthrough febrile UTI.
Beyond 5 year: prophylaxis
continued if there is bowel bladder
dysfunction.
72. CONCLUSION
Care must be taken in assessing individual patient.
Drugs must be used in adequate doses and for
adequate period.
Bactericidal drugs are to be preferred for treatment.
All pregnant women should be screened in first
trimester and treated.
For nosocomial UTIs
“prevention is better than cure”
73. Sharma H.L.Quinolones and treatment of urinary
tract infections,Principal of pharmacology; 2nd
edition:708-715.
Satoskar R.S.,Chemotherapy of urinary tract
infection, Pharmacology and
pharmacotherapeutics;22 edition:717-725
Stamm W.E. Urinary tract infections,Harrison,
Principle of internal Medicine; 17th edition:1820-
1826
74. REFERENCES
Petri W.A. Agents for urinary tract infection,
Goodman and Gilman, The pharmacological basis
of therapeutics;12 Edition:1463-1476
Tripathi K.D..Urinary antiseptics,Essentials of
medical pharmacology; 7th edition: 760-764
Katzung B.G. Treatment of Urinary Tract, Katzung
B. Basic and clinical pharmacology;11 edition:439-
450
75. Indian society of Pediatric nephrology, Revised
statement on management of urinary tract infection,
vol 48, sept 17 2011, 709-717.