UTI.pptx THIS SLIDE FOR MEDICOS STUDENTS

SLIDE FOR MEDICOS STUDENTS

1. Urinary tract infection & Sexually transmitted diseases From: Dr. Swati Rai Assistant Professor ASMC,SULTANPUR,UP

2. Urinary Tract Infection Pyelonephritis Ureteritis Urethritis Cystitis Upper UTI Lower UTI Vesico-ureteral Reflux

3. Upper Urinary tract (Kidney, Ureter)- Less common but More dangerous, Long term therapy Lower Urinary tract (Bladder, Urethra)- More common but Less dangerous Short term therapy

4. Symptoms

5. Symptoms - ( S evere P ain D uring UTI ) S ystemic symptoms- myalgia, vomiting, weakness etc. P ain (Pelvic, Rectal, lower abdomen or renal angle) P ungent smell of urine D ysuria (Burning), D enies urination (Fear of Urination) D ischarge through urethra D iscoloration of urine (Haematuria, Pyuria, Haziness, Clouding) U rgency T emperature (Fever with chills) I ncomplete emptying (Retention) I ncontinence of urine

6. More common in Females- Anatomical differences Other part involved - Prostate, Epididymis More common if- S tones S trictures S tents (Urinary Catheter) S tructural abnormality S traight entry of ureter S exually active S tore urine (Faulty urinary habit) S urgical (abdomen) S canty fluid intake S emiconscious (Unconscious), S ite trauma,

7. Organisms- Mostly Gram Negative ( E.coli, Klebsiella, Proteus, Pseudomonas, Enterobacter,) Others- Staphylococcus, Viral, Fungal, … Single in acute, mixed in chronic Entry - Mostly from lower to upper ( Ascending ), Some times Directly from the surrounding sites or From blood (bacterimia)

8. Antiseptic agents for UTI UT antiseptics concentrated in urine Inhibit the growth of bacteria Systemic infection Can’t be used WHY? Effective concentration in plasma is not achieved.

9. Methenamine Hexamethylenamine UT antiseptics Prodrug generate Formaldehyde N4(CH2)6 +6H2O+4H+ = 6HCHO+ 4NH +4

10. pH matter : At pH 7.4 – No decomposition pH 6 - 6% formaldehyde pH 5 – 20% Acidification inc. Promotes formaldehyde formation Formaldehyde dependent antibacterial action

11. Decomposition reaction is slow 3hr require to reach 90% completion

12. Antimicrobial activity At concentration Formaldehyde (20microgm/ml) All bacteria are sensitive Urea splitting microorganism ( proteus ) Inc pH of urine Inhibit the release of formaldehyde

13. A – Orally 10%-30% decomposes in gastric juice So , drug should be protected by enteric coating At pH6 , Ur. Daily volume – 1000, 1500 ml ,daily dose of 2g yield Ur con. 18 -60 microgm /ml of formaldehyde

14. Low pH alone is bacteriostatic , so acidification serves a double function Acid commonly used - Mandelic acid, Hippuric acid C/I : Renal insufficiency Antagonism effect with SULFONAMIDE. So not combined

15. Use: Chronic suppresive t/t of UTIs E.coli S.aureus S.epidermis

16. Nitrofurantoin Synthetic nitrofuran Antimicrobial activity It is activated by enzymatic reduction Active against E.coli , enterococci Bacteriostatic -32microgm/ml Bacteriocidal – 100microgm/ml

17. A – Orally , rapidly T1/2 : 0.3 -1 hr 40% excreted unchanged into urine Dosage: 50-100mg Children: 5-7 mg/kg Course shouldn’t be exceed 4 days

18. C/I Pregnancy Individual with impaired renal function Crcl < 60ml/min Children < 1 mnth

19. Approved – Lower UTIs T/T of pyelonephritis Prostatitis S/E : N/V/D Chronic : Interstitial pulmonary fibrosis

20. Fosfomycin Phosphonic acid derivative Prevention & T/T of UTIs MOA: Inhibit MurA , an enolpyruvyl transferase that catalyze the initial step in bacterial cell wall synthesis E.coli , Enterococus , Proteus, Staphlococus , Saphrophyticus T1/2: 5-8hr

21. Uncomplicated UTI : 3g single dose Complicated UTI : 3g every other day for 3 dose 3g every 10 days for UTI prophylaxis S/E : GI distress Vaginitis Headache Dizziness

22. Antimicrobials- ----------------------- (Q-BACTS) Q uinolones -(Nalidixic acid, Norfloxacin……) B etalactams- Ampicillin/ Amoxicillin, A minogycosides- Gentamicin, Amikacin, … C ephalosporins- Third generation T etracyclines - S ulfonamides and Cotrimoxazole Other Antimicrobials- Chloramphenicol, Methicillin, Carbenicillin etc……..

23. Prophylaxis for UTI- Needed in Catherised, Uncorrectable anatomical abnormalities Inoperable prostate, Septicemia, Immuno-compromised, Trauma Note- In patients with impaired renal functions avoid Nitrofurnatoin, Nalidixic acid, Aminoglycosides, Potassium salt, and Acidifying agents

24. V V V

25. Sexually Transmitted Diseases (STD) (Sexually Transmitted Infections (STI) Transmitted through sexual contacts Usual Presentations Genital ulcers Discharge (Urethral and vaginal) Abdominal Pain Swelling surrounding genital area Systemic symptoms (Fever, weakness etc. )

26. Important STDs Syphilis (Chancre (Hard sore, Painless) Chancroid (Soft sore, Painful) Gonorrhea Non-gonococcal urethritis (Nonspecific) Chlamydia, Ureoplasma, Haemophillus, Mycoplasma Herpes genitalis AIDS (HIV) Hepatitis B Donovaniasis Trichomoniasis Wart (Genital Wart, Human Papilloma Virus strain 6 and 11) Pubic Lice Lymphogranuloma inguinalae

27. C hancroid H erpes genitalis H epatitis B A IDS (HIV) N on-gonococcal urethritis D onovaniasis W art (genital) S yphilis T richomoniasis L ymphogranuloma inguinalae L ice G onorrhea C lean HAND W ith S oap T o L oose G erms

28. Types of Sexually Transmitted Infections Bacterial Viral Parasitic Chlamydia Gonorrhea Syphilis HPV (Genital Warts) HIV Herpes Hepatitis B Pubic Lice (“crabs”) Trichomoniasis

29. DISEASES DRUG OF CHOICE Neisseria gonorrhoea ( gonococcus) Ceftriaxone 250 mg I.M/ Azithromycin/ Doxycycline Amoxicillin/ Cefixime/ Ciprofoxacin (Single dose) 2. S yphillis -Primary( chancre) Early -Secondary ( Condeloma Lata ) -Latent (< 1 yr) Procaine Penicillin-G 2.4 M.U. daily for 10 to 14 days or Benzathine penicillin G 2.4 M.U Once - Latent (>1 yr) or -cardiovascular syphillis -Tertiary - Neurosyphillis Benzathine penicillin G 2.4 M.U. weekly for 3 weeks or Procaine Penicillin G 2.4 M.U. for 3 weeks

30. DISEASES DRUG OF CHOICE 3. Herpes simplex Acyclovir/ Valacyclovir 4. Chalmydiae trachomatis (Non specific urethritis ) Lymphogranuloma venereum Doxycycline 100 mg BD for three weeks or Azithromycin 1 gm oral per week for three weeks 5. Donovanosis ( Calymmatobacterium granulomatis ) Granuloma Inguinale Azithromycin 1g per week for 3 weeks or Doxycycline 100mg BD for 3 weeks 6. Chancroids ( Haemophilus ducreyi ) Azithromycin 1g oral single dose Or Ceftriaxone 250 mg I.M sing dose or Erythromycin 500 mg QID for one week

31. 7.Condyloma acuminatum Human Papilloma Virus strain 6 and 11 Treatment Antiviral therapy: Interferon, Valaciclovir Regional treatment : Podophyllotoxin Laser, freezing (Cryosurgery) Microwave Big wart: excise by operation Remember it ‘s different: To Condyloma lata- Secondary Syphilis

32. 8. Hepatitis B- Lamivudine 9. HIV- Zidovudine and other ART