Management of UTI.pptx

Treatment of Urinary tract infection

1. Management Of UTI

2. Introduction Symptomatic presence of micro organisms within the urinary tract i.e., kidney, ureters, bladder and urethra. Associated with inflammation of urinary tract.

3. Significant bacteriuria : presence of at least 10 5 CFU/m l of urine. Asymptomatic bacteriuria : bacteriuria with N o symptoms. Urethritis : infection of anterior urethral tract dysuria, urgency and frequency of urination. Cystitis: infection to urinary bladder dysuria, frequency and urgency, pyuria and haematuria.

4. Acute pyelonephritis : infection of one/both kidneys ; characteristically Fever and flank pain Chronic pyelonephritis : particular type of pathology of kidney ; may/may not be due to infection.

5. Epidemiology Women – at greater risk than men; prevalence 40-50% in women and 0.04% in men. 10% women have recurrent UTI in their life Incidence of UTI increases in old age; incidence similar in men & women .

6. Etiology Acute uncomplicated UTI: Escherichia coli – cause about 80% of UTI 20% of UTI caused by- Gram negative enteric bacteria – Klebsiella, Proteus Gram positive cocci – Streptococcus faecalis Staphylococcus saprophyticus S.saprophyticus – restricted to infections in young sexually active women.

7. UTI – RISK FACTORS Aging: D iabetes mellitus Incomplete bladder emptying I mpaired immune system Females : shorter urethra sexual intercourse Males : prostatic hypertrophy age

8. Clinical manifestations depending on site of infection Urethritis: Discomfort in voiding Dysuria Urgency frequency

9. t Cystitis: dysuria, urgency a nd frequen t urination Abdominal pain (Suprapubic) Pyuria Hemorrhagic cystitis: Visible blood in urine. Irritating voiding symptoms Pyelonephritis Fever Flank Pain Systemic symptoms

10. UTI- DIAGNOSIS Microscopic examination of urine Urinalysis Urine culture Imaging techniques – CT scan and MRI

11. UTI - management Symptomatic UTI- antibiotic therapy Asymptomatic bacteriuria - no treatment required except in special situations. Non- specific therapy: M ore water intake. Maintaining acidity of urine by fluids like c r anberry juice. Phenazopyridine (analgesic)

12. Acute uncomplicated Lower UTI 1 st LINE: Nitrofurantoin 100 mg twice daily for 7 days Cotrimoxazole 1 DS(160/480 mg) twice daily 3-5 days Fosfomycin 3g single dose Pivmecillinam 2 nd LINE Fluoroquinolones Amoxicillin-clavulanate

13. Complicated Cystitis 1 st LINE Oral or parenteral FQs for longer duration (10-14 days) Other agents: Ampicillin, Piperacillin-tazobactam, Imipenem- cilastatin Switch to oral therapy once clinically improved

14. Acute Pyelonephritis Parenteral antibiotic followed by oral therapy for 10-14 days Drugs: Nitrofurantoin not used Ciprofloxacin or levofloxacin FQ resistance, Ceftriaxone or gentamicin and co-amoxiclav, carbapenems

15. Severe complicated UTI (Sepsis/ICU pts) ESBL producing organisms/Pseudomonas/MRSA : Carbapenems plus Vancomycin Meropenem- vaborbactam

16. UTI in Pregnancy DOC ampicillin or cephalosporins ASB should be treated for 4-7 days Pyelonephritis: Parenteral Beta-lactams FQs avoided

17. UTI in Men Acute bacterial prostatitis: FQs or cotrimoxazole for 2-4 weeks Chronic bacterial prostatitis: 4-6 Weeks Recurrence- 12 week course.

18. Prophylaxis for UTI Recurrent cystitis Catheterisation Anatomical defects Inoperable prostatic enlargement Drugs used: Cotrimoxazole 480 mg Nitrofurantoin 100 mg Cephalexin 250 mg Either of them once daily for 6 months.

19. Antibiotics used in treatment

20. Sulfamethoxazole-trimethoprim Adverse effects: Steven Johnson's syndro me Dermatitis Angiodema GI disturbances Agranulocytosis Contraindicated in Hypersensitivity to sulfa drugs Infants Megaloblastic anaemia Mechanism of action

21. N itrofurantoin Damages bacterial DNA. Reduced to reactive forms by bacterial nitroreductase- damage DNA, ribosomes Adverse effects: Hypersensitivity pneumonitis, hemolytic anemia Contraindications: Renal failure, neonates, pregnancy

22. Amoxi c illin Beta-lactam antibiotic Inhibits cross linking of peptidoglycan polymer chains which is the major component of bacterial cell wall. Adverse effects: Rash Antibiotic associated colitis Contraindications: penicillin hypersensitivity

23. Ciprofloxacin Fluoroquinolone antibiotic Inhibits DNA gyrase and top o isomerase I V, the enzymes necessary for separation of bacterial DNA – inhibit cell division Adverse effects: CNS: Impairment of concentration, tremors, seizures (rare) Tendinitis and tendon rupture rarely FDA issued warning of hypoglycemia

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