Topic of discussion: Urinary Tract Infections,their etiologies. The organisms responsible for the infection of the urinary tract as well as the clinical approach to the treatment of Urinary Tract Infections (UTIs).

1. Clinical & Pharmacological
Approach to Drug Selection in
the Urinary Tract infections

2. • Is markedly increased in incidence in
women, presumably because of the very
short length of the female urethra; increased
during pregnancy

3. General Characteristic of UTIs
• Can be caused by
hematogenous bacterial
dissemination to the
kidney or by external
entry of organisms
through the urethra into
the bladder; in the latter
case infection can spread
upward from the bladder
into the ureters (vesico-
ureteral reflux) and
through the ureters to the
kidney (ascending
infection)

4. • Most frequently involves the normal flora of
the colon, most often Escherichia coli
General Characteristic of UTIs

5. General Characteristic of UTIs

6. Predisposing Factors
• Obstruction of urinary flow
• Surgery on the kidney or urinary tract
• Catheters inserted through the urethra into the
bladder
• Gynecologic abnormalities

7. Clinical Manifestations
• Urinary frequency – a compelling necessity to
void small amounts of urine at frequent intervals
• Dysuria – painful, burning sensation on
urination
• Pyuria – large numbers of neutrophils in the
urine
pyuria
bacteriuria

8. Clinical Manifestations
• Hematuria – blood in the urine; urinary red cells
are a nonspecific finding in urinary tract infection
• Bacteriuria – usually defined as more than 10.5
organisms per milliliter of urine; must be
distinguished from contamination of urine
specimens by external flora

9. Treatment of UTIs
• Treatment duration 7 days is required
• For unpregnant women with lower tract
symptoms, 3 days of 8-Fq (Cipro 250 mg BID) is
as effective as 7 days of therapy with fewer
adverse effects

10. Uncomplicated UTIs Treatment
• First Line
• Nitrofurantoin 50‐100 mg QID or Macrobid 100 mg
BID (AVOID if CrCl < 40‐60mL/min)
• Alternatives
• Ciprofloxacin 250 mg BID (↓ dose if CrCl < 50 mL/min)
• Levofloxacin 250 mg QID
• Amoxicillin 500 mg TID (500 mg BID if CrCl < 50
mL/min)
• Amoxicillin/Clavulanate 500/125 mg TID or 875/125
mg BID (500 mg BID if CrCl < 50 mL/min)
• TMP/SMX 160/800 BID (↓ dose if CrCl < 30 ml/min)
• Trimethoprim 200 mg BID

11. Complicated UTIs Management
• Includes residents with structural or functional
abnormalities such as: obstruction, chronic
catheter, spinal cord injury, etc.
• Are characterized by mixed culture bacteriology
and generally more resistant types of organisms
• Recurrent infection is common (50% by 6 weeks
post therapy)
• Generally require longer treatment duration
compared to uncomplicated UTI (14 days)

12. Complicated UTIs Treatment
• First Line
• Nitrofurantoin 50‐100 mg QID or Macrobid 100
mg BID (AVOID if CrCl < 40‐60mL/min)
• Ciprofloxacin 500 mg BID or 1 g once daily
(↓ dose if CrCl < 50 mL/min)
• Levofloxacin 500 mg once daily or 750 mg daily
• TMP/SMX 160/800 2 tabs BID (↓ dose if CrCl <
30 ml/min)
• Trimethoprim 200 mg BID

13. Complicated UTIs Treatment
• Second Line
• Amoxicillin/Clavulanate 500/125 mg TID or
875/125 mg BID (500 mg BID if CrCl < 50
mL/min)

14. Severe UTIs Treatment
(2-4 weeks treatment duration)
• First Line
• Ciprofloxacin 500 mg BID (↓ dose if CrCl < 50 mL/min)
• Levofloxacin 250-500 mg QID
• Alternatives
• Amoxiclav 1,2 g TID i/v
• Cefotaxime 2 g TID i/m, i/v
• Ceftriaxone 1-2 g QID i/m, i/v
• Cefepime 1-2 g BID i/m, i/v
• Gentamycin 5 mg/kg TID i/m
• Amikacin 15 mg/kg QID i/m
• Imipenem/Cilastatin 0,5/0,5 g TID i/v
• Meropenem 1 g TID i/v