This document discusses treatment options for urinary tract infections (UTIs). It covers various classes of antibiotics used including quinolones, beta-lactams, cephalosporins, tetracyclines and others. It recommends that the choice of antibiotic depends on the likely susceptibility of the pathogen, ease of administration, efficacy, safety and cost. Short 3-day courses are often effective for uncomplicated UTIs, while more complicated cases may require longer treatment up to 6 weeks. The duration and choice of antibiotic also depends on factors like pregnancy, diabetes, anatomical abnormalities and resistance patterns in the local area.

2. Index
 Introduction
 Pharmacotherapy
• Quinolones
• BetaLactams
• Cephalosporin
• Tetracyclin
 Duration
 Dose
 Diseases

3. Introduction
Urinary tract infection (UTI) is one of the most common disorders treated by medical practitioners
and UTIs account for a significant percentage of healthcare costs.Many antibiotics once used to treat
UTI are now ineffective due to the development of antimicrobial resistance. The primary UTI pathogen
is Escherichia coli, but other members of the Enterobacteriaceae family of organisms also
commonly cause infection, including Klebsiella pneumoniae, Enterobacter and Citrobacter spp.
Emergence of MDR bacteria, including AmpC β-lactamase-, ESBL- and carbapenemase-producing strains of
Enterobacteriaceae, has complicated treating patients with these infections.
Because of the many newly developed chemotherapeutics it is often hard to
choose the most suitable substance for treatment of urinary tract infection (UTI). It is easier to decide
which substance to give before urine culture results are available if the local resistance patterns
to the typical pathogens are known. Particular care is mandatory for risk groups such as
children, pregnant women, immunocompromised patients and those with renal insufficiency.
Before treatment clinical classification of UTI is necessary

4. Pharmacotherapy (Q-Bacts)
Quinolones (Nalidixic Acid, Norfloxacin)
Beta Lactams (Ampicillin, Amoxycillin)
Aminoglycosides (Gentamycin, Amykain)
Cephalosporins (Third Generation)
Tetracyclins
Sulphonamides
CHOICE OF DRUG A renaly excreted antibiotic with a long half-life, effective in short courses with a low
incidence of side-effects is ideally required in the treatment of UTI. Variation in antibiotic sensitivities
exist between different areas and if a local antibiotic prescribing policy exists this should be adhered to.
The choice depends on the likely susceptibility of the organism, ease of administration, efficacy, freedom
from adverse effects and relative cost.

5. Quinolones
Quinolones/fluoroquinolones
There are three generations of quinolone antibiotics. The first is represented by
nalidixic acid and derivatives. In terms of second-generation quinolones, those still used for
UTIs are broad-spectrum agents such as ciprofloxacin, ofloxacin, lomefloxacin, norfloxacin and prulifloxacin.
Third-generation quinolones include newer agents that are especially active against
Gram-positive bacterial species and anaerobes and are therefore not clearly indicated for UTIs,
Differences between the different generations are due to modifications in the structural formula,
resulting in different activity

6. Beta Lactams
The beta-lactams, characterized by a mechanism of action targeting the bacterial cell wall,
are generally active against both Gram-positive and Gram-negative bacteria. These antimicrobial
agents have a time-dependent killing activity at therapeutically achievable concentrations.
They have minimal to moderate persistent antibiotic effects, and their efficacy is optimized
by maximising the duration of exposure. Resistance in Enterobacteria is mainly due to inactivation
by hydrolytic enzyme production (beta-lactamases). Therefore, there is a tendency to use
aminopenicillins in combination with suicide inhibitors (e.g. amoxicillin-clavulanic acid) or oral cephalosporins

7. Cephalosporin
Cephalosporins are useful for UTI's which do not respond to other drugs.
Characteristics of individual cephalosporins may vary. Cephalexin, cephradine, cefaclor and cefadroxil
may be used with caution during pregnancy and lactation.They are also thought not to interact with the OCP.
Hypersensitivity is the main adverse effect. Resistant organisms are more commonly
isolated in institutional settings or following multiple antibiotic exposures.
Poor clinical and bacteriologic responses limit prescribing of these agents for UTI.
They are more expensive than trimethoprim and should serve only as alternatives.
Tetracyclins
They are not recommended. Doxycycline are sometimes used because
less bacterial resistance develops, good urine concentrations are achieved and it can be given twice daily.
Note: In patients with impaired renal functions, avoid Nitrofurantoin, Nalidix acid,
Aminoglyosides, Pottasium salts

8. Duration Of Treatment
 The traditional approach to treatment of lower UTI was 7 to 14 days of therapy
but studies suggest that shorter 3 day courses are as effective.
 In the majority of women with symptoms indicating uncomplicated UTI,
cure rates with 3 day therapy with e.g. trimethoprim appear comparable
to those achieved with longer courses.
 Single dose regimens e.g. amoxycillin 3g, fosfomycin 3g have been evaluated
for the treatment of uncomplicated UTI with varying cure rates (60-100%) reported.
Further studies are required before they can be routinely recommended.
 For bacteriuria of pregnancy, a 7 day course of e.g. nitrofurantoin should be followed
by a repeat urine culture to confirm clearing of the organism.
 Longer courses of up to 4-6 weeks are recommended for women who relapse early with
the same organism, for patients with diabetes, polycystic kidney disease and
for renal transplant recipients, all of whom are more likely to have complicated infections.
 Short course therapy should not be used for men, for patients with pyelonephritis, symptoms
lasting more than seven days, anatomical or functional abnormalities of the urinary tract,
immunosuppression or indwelling catheters or in those who have a high probability of having
resistant bacteria.
 In children, treatment is usually given for seven days initially and
may be followed by low dose prophylaxis until investigation of the urinary tract is completed

9. Disease Drug Regimen

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