DRUGS OF UTI

Pharmacology 1st year

1. TREATMENT OF UTI GROUP - E

2. WHAT IS UTI ? UTI is a microbial invasion or presence of organism under multiplying condition in urinary tract. They are mainly of two types :- Upper UTI includes pyelonephritis and ureteritis . Lower UTI cystitis and urethritis Causative organism : E.coli , Klebsiella , Proteus , Pseudomonas , Staph. Saprophyticus , Herpes Simplex virus , Adenovirus , Candida spec. , Trichomonas vaginalis .

3. Treatment of UTI Majority of acute infections caused by E.coli while chronic & recurrent maybe mixed infections. Three days regimen is considered optimal for lower UTI while Upper UTIs require more aggressive & longer treatment Bacteriological investigations are important for the choice of drug for which urine is collected before commencing therapy. Least toxic & cheaper AMA that doesn’t disrupt the normal gut & perineal flora is preferred

4. ANTIMICROBIALS USED IN UTI : 1) PROTEIN SYNTHESIS INHIBHITOR RIBOSOMAL SUBUNIT AND INHIBIT PROTEIN SYNTHESIS 30S 30S 50S 50S Tetracycline Gentamicin Chloramphenicol Macrolides

5. DRUGS USED IN UTI : 2) CELL WALL SYNTHESIS INHIBHITOR Cell Wall Synthesis Inhibitor Penicillin Cephalosporins 3) NUCLEI ACID SYNTHESIS INHIBITOR - Fluoroquinololes : Inhibit DNA replication Cotrimoxazole : Inhibit folic acid synthesis

6. FLUOROQUINOLOLES First quinolone, nalidixic acid is seldom employed First generation fluoroquinolones highly effective MOA :- DNA Gyrase in g ram – negative and Topoisomerase IV in gram positive bacteria Nicking, formation Of negative super- Coils and resealing Of strands of DNA

7. FLUROQUINOLOLES Useful in treatment of complicated UTI Contraindicated in pregnancy ADR : Nausea , vomiting , Abd . discomfort , headache , insomnia , hypersensitivity reactions ,tenosynovitis and tendon rupture

8. COTRIMOXAZOLE Fixed dose combination of Sulfomethoxazole & Trimethoprim in the ratio 5:1 MOA : PABA DHFA THFA SULPHONAMIDE TRIMETHOPRIN FOLATE SYNTHASE DHF REDUCTASE USES: Empirically in acute UTI Contraindicated in pregnancy

9. β -LACTAMS MOA: Binds to penicillin binding protein (PBP) & thus prevents the transpeptidation Ampicillin/Amoxicillin : Most frequently used AMA in severe complicated UTI in combination with Clavulanic acid Cephalosporin : Third generation used especially in women with Nosocomial infections caused by Klebsiella & Proteus. Used a empirical treatment of acute lower UTI

10. PROTEIN SYNTHESIS INHIBITORS Gentamicin : Binds to 30s ribosomal subunit In acute pyelonephritis, Gentamicin + Coamoxiclav used empirically Chloramphenicol: Binds to 50s ribosomal subunit Use restricted to pyelonephritis due to its toxicity.

11. URINARY ANTISEPTICS METHENAMINE MOA : Methenamine Formaldehyde + Ammonia Formaldehyde inhibits both gram positive and negative organism and produces bactericidal activity . Ineffective against urea splitting organisms ( proteus spec.) USES :- Chronic suppressive therapy in recurrent UTI ADR : Nausea , vomiting , diarrhea , hematuria at high dose (Prodrug) (active antiseptic ) (mandelic acid makes The urine acidic) (pH < 5.5)

12. NITROFURANTOIN MOA : Susceptible organism r educes nitrofurantoin into active metabolite which damages the DNA . Bacteriostatic but bactericidal at high concentration. More active in acidic ph. Effective for prophylaxis of UTI due to E .Coli ADR : Nausea , vomiting , diarrhea , hypersensitivity reactions

13. URINARY ANALGESICS : PHENAZOPYRIDINE MOA : Is a dye and has analgesic action & provides symptomatic relief in urinary tract. Makes the urine orange red which is harmless ADR :- Occasionally nausea and vomiting

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