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Urinary Tract Infection
Urinary Tract Infection (UTI)
• UTI is the 2nd most common infectious presentation in community practices
• World wide, about 150 million people are diagnosed with UTI each year
Ann Clin Micr Anti 2007;6:4-12
UTI is an inflammatory response of the urothelium to bacterial invasion
Campbells Urology 2007; 9th Ed
Urinary Tract Infection (UTI)
UTI can occur in females and males, in all age groups
Prevalence
35% of healthy women suffer symptoms of UTI at some time in their life
Common in women
Medicine 2007;35:423-427
Why greater susceptibility of UTI in women?
The female urethra
• short length (~4cm)• proximity to anus
Urethra is prone to colonization with bacteria (Fecal bacteria)
Medicine 2007;35:423-427
Prevalence
• Rare in Males• Anatomical or functional abnormality of the urinary tract
8% of girls and 2% of boys will have UTI in childhood
• Increases in elderly• 21% of women and 12% of men over 65 yrs of age have UTI
Medicine 2007;35:423-427
BMJ 1999;319:1173-1175
Pathogenesis
Most UTI occur in women who are healthy
Interaction between the bacterial virulence and host defence
Increase in virulence
Decrease in host defence
Infection+
Medicine 2007;35:423-427
Routes of Infection
Common route – Ascending through urethra
Other route – Blood and lymphatic
EAU Guidelines 2006
UTI
Community acquired UTI
NosocomialUTI
UTI - Classification
EAU Guidelines 2006
Uncomplicated UTIs Complicated UTIsInfection involving normal
urinary tractPresence of metabolic,anatomic and functional
abnormalities
UTI
UTI - Classification
EAU Guidelines 2006
Healthy non-pregnant women • Pregnancy• Catheterization• Diabetes• Infection stones
Site of origin
Epididymitis
Prostatitis
Pyelonephritis
Cystitis
Urethritis
UTI - Classification
Orchitis
EAU Guidelines 2006
Risk factors associated with UTIs
Uncomplicated Complicated
• Sexual intercourse• Spermicide creams• Diaphragm• Previous UTI
• Pregnancy• Catheterization• Diabetes• Infection stones• Male• Elderly
Medicine.2007;35:423-427
Clinical presentation of Uncomplicated UTI
Common symptomatic infection in young non-pregnant women is uncomplicated
cystitis
• Asymptomatic bacteriuria• Acute Cystitis• Acute Pyelonephritis
EAU Guidelines 2006
Causative organisms
Acute Uncomplicated cystitis
E.Coli : 70- 95%Staphylococcus.saprophyticus :10-15%Klebsiella species Proteus mirabilis
Arch Intern Med.2007;167:2207-12
Causative organisms
Acute Uncomplicated pyelonephritis
E.Coli – 80%Klebsiella species Proteus mirabilisOther enterobacteriaStaphylococcus aureus
Prim Care Clin Office Pract 2008;35:345-367
Symptoms of Uncomplicated cystitis
If both dysuria and frequency present in the absence of vaginal
discharge, the chance of UTI is ~90%
• Dysuria• Frequency• Urgency • Hematuria• Suprapubic pain
Campbells Urology 2007; 9th Ed
Symptoms of Uncomplicated pyelonephritis
• Fever • Flank pain• Nausea• Vomiting • Abdominal pain
The patient may or may not have symptoms of cystitis
Prim Care Clin Office Pract 2008;35:345-367
Diagnosis
History
• Symptoms of UTI• Other History (eg. Vaginal discharge)
Examination
Pelvic examination to rule out other causes like urethritis and vaginitis
EAU Guidelines 2006
Diagnosis
Urine Analysis
-Dipstick method
• Nitrite• Leukocyte esterase
- Microscopic analysis
• Bacteriuria• Pyuria• Hematuria
EAU Guidelines 2006
Diagnosis
Urine Culture
Not recommended in case of cystitis but doneif pyelonephritis suspected or complicated UTI
Ultrasonography
CT scan
EAU Guidelines 2006
Treatment for Uncomplicated Cystitis
Short term antibiotics( EAU recommendation - Drugs of first choice)
Drug Dose DurationNitrofurantoinNitrofurantoin
macrocrystalsmacrocrystals
100mg, bid100mg, bid 5-7days5-7days
Fosfomycin trometamol°
1 day
3 g SD 1day1day
Pivmecillinam
Pivmecillinam
400 mg bid
200 mg bid
3 days
7 days
EAU Guidelines 2010
Ciprofloxacin 250 mg bid 3 days (CIPLOX) Levofloxacin 250 mg qd 3 days (LEVOFLOX) Norfloxacin 400 mg bib 3 days (NORFLOX) Ofloxacin 200 mg bid 3 days Cefpodoxime proxetil 100 mg bid 3 days (CEFOPROX)
If local resistance pattern is known (E. coli resistance < 20%):
Trimethoprim–sulphamethoxazole 160/800 mg bid 3 days Trimethoprim 200 mg bid 5 days
Treatment for Uncomplicated Cystitis (Alternatives)
EAU Guidelines 2010
Oral therapy in mild and moderate cases Ciprofloxacin 500–750 mg bid 7–10 days Levofloxacin 250–500 mg qd 7–10 days Levofloxacin 750 mg qd 5 days
Alternatives (clinical but not microbiological equivalent efficacy compared with fluoroquinolones):
Cefpodoxime proxetil 200 mg bid 10 days Ceftibuten 400 mg qd 10 days
Only if the pathogen is known to be susceptible (not for initial empirical therapy):
o Trimethoprim–sulphamethoxazole 160/800 mg bid 14 days o Co-amoxiclav 0.5/0.125 g tid 14 days
Treatment for Uncomplicated Pyelonephritis
Recommendations as per EAU guidelines
EAU Guidelines 2010
Treatment for Uncomplicated Pyelonephritis
In severe cases of pyelonephritis
• Hospitalization• Parenteral antibiotics (Quinolones and beta lactamase inhibitor)• With improvement switch to oral therapy to complete the course
EAU Guidelines 2006
Choice of antibiotics should take into account not only the spectrum of activity
but also resistance
Susceptibility Patterns of Susceptibility Patterns of E.ColiE.Coli from 2003-2007 from 2003-2007 International dataInternational data
0
20
40
60
80
100
120
E.coli-2003 E.Coli-2004 E.Coli-2005 E.Coli-2006 E.Coli-2007 Average
TMP/Sulfa
Ciprofloxacin
Levofloxacin
Nitrofurantoin
% S
usce
ptab
ility
J Urol 2008;178:84
E.coli has highest susceptibility for Nitrofurantoin
Susceptibility patterns of E.coli to variousantibiotics : Indian data
0102030405060708090
100
T/S A Nx Cf G Ce Ci Nf
T/S- Trimethoprim/Sulfamethoxazole; A- Ampicillin; Nx-Norfloxacin; Cf-Ciprofloxacin; G-Gentamicin; Ce-Cefotaxime; Ci-Ceftriaxone; Nf-Nitrofurantoin
Indian J Med Sci 2006;60:53-58
E.coli has highest susceptibility for Nitrofurantoin
Resistance
• Infecting organisms are not susceptible to antimicrobial agent selected
• Invariably patient has received recent antimicrobial therapy which produces resistance
Campbells Urology 2007; 9th Ed
Incidence of recurrenceIncidence of recurrence
• One in four women will develop recurrence
• 27% of women will experience a recurrence within 6-12 months
Best Pract Res Clin Obstet Gynaecol 2005;19:861-873
Resistance rates in E coli: International data
38
21
6
1
0
5
10
15
20
25
30
35
40
Ampicillin TMP-SMX Cipro Nitro
Res
ista
nce
rat
es in
E c
oli
%
Urol Clin Am;2008:35:69-79
Nitrofurantoin has least resistance compared to other commonly used antibiotics
Resistance to TMP-SMX is more than 75%
Resistance rates in E coli: Indian data
More than 80% of the fluoroquinolone resistant strains were found to be
sensitive to Nitrofurantoin
Indian J Med Sci 2006;60:53-58
Resistance to Fluoroquinolones is as high as 69%
Prim Care Clin Office Pract 2008;35:345-367
Follow-up
Urine Analysis- Bacteriuria
Urine culture- If symptoms do not resolve or recur within 2 weeks
EAU Guidelines 2006
Recurrence
Recurrent UTI is defined as 3 episodes of UTI in the last 12 months or 2 episodes in the
last 6 months
Recurrent UTI occur in 20-25% of women
Risk Factors History of UTI in mother Behavioural factors - Frequency of sexual intercourse - Spermicide cream - Diaphragm EAU Guidelines 2006
Medicine.2007;35:423-427
Prophylaxis for Recurrent UTI
Pharmacological- Antibiotic prophylaxis
Non Pharmacological- Voiding after intercourse- Cranberry juice- Alkalizer (Potassium citrate)
EAU Guidelines 2006
Antibiotic prophylaxis
Long term prophylactic antimicrobials - Taken regularly at bedtime
Post coital prophylaxis- When related to sexual intercourse
95% decrease in UTI episodes/pt year
EAU Guidelines 2006
EAU Guidelines 2010
Long term prophylactic antimicrobials
Taken at bedtime
Drug Dose
NitrofurantoinNitrofurantoin 50/100mg/day50/100mg/day
TMP-SMXTMP-SMX 40/200mg/day or three times weekly40/200mg/day or three times weekly
CefaclorCefaclor 250mg/day250mg/day
CephalexinCephalexin 125/250mg/day125/250mg/day
NorfloxacinNorfloxacin 200mg/day200mg/day
CiprofloxacinCiprofloxacin 125mg/day125mg/day
Fosfomycin 3 g every 10 days
Post coital prophylaxis
EAU Guidelines 2010
Drug Dose
TMP-SMXTMP-SMX 40/200mg40/200mg
NitrofurantoinNitrofurantoin 50/100mg50/100mg
CephalexinCephalexin 250mg250mg
CinoxacinCinoxacin 250mg250mg
CiprofloxacinCiprofloxacin 125mg125mg
NorfloxacinNorfloxacin 200mg200mg
OfloxacinOfloxacin 100mg100mg
0
10
20
30
40
50
60
70
80
90
No
of
pa
tien
ts
No of symptomatic episodes
Long term prophylaxis with nitrofurantoin for 1year (18 years of experience)
Significantly higher no of patients had no symptomatic episodes of UTI
J Antimicrob Chemother.1998;42: 363-371
0 1 2 3 4 5 6 7 8
Nitrofurantoin has maintained its place in the treatment of UTI due to least
resistance
Different forms of Nitrofurantoin
• Nitrofurantoin Microcrystalline - Introduced in 1953
• Nitrofurantoin Macrocrystals - Introduced in 1968
• Nitrofurantoin Monohydrate/Macrocrystals - Novel formulation
J Antimicrob Chemother.1998;42: 363-371
Nitrofurantoin Microcrystalline form hadLimitations like
Nitrofurantoin Macrocrystalline form superior to Nitrofurantoin Microcrystal form
- Severe GI side effects like nausea and vomiting- Four times daily dosing
- Better GI tolerability
Nitrofurantoin Monohydrate/Macrocrystal superior to both
- Better GI tolerability- BID dosing
J Antimicrob Chemother.1998;42: 363-371
010
2030
4050
6070
BID QID
Co
mp
lian
ce(%
)BID dosing associated with significantly
better compliance than QID dosing
Nitrofurantoin monohydrate/macrocrystals
Nitrofurantoin microcrystalline
J Antimicrob Chemother.1998;42: 363-371
Nitrofurantoin Monohydrate/Macrocrystals provides BID dosing and
retains the efficacy and safety profiles of Nitrofurantoin macrocrystals
J Antimicrob Chemother.1998;42: 363-371
Complicated UTI
• Pregnancy
• Diabetes
• Paediatric UTI
• Catheter associated urinary tract infection (CAUTI)
• Prostatitis
UTI in PregnancyUTI in Pregnancy
Pregnancy
UTIs are detected in 2 to 8% of pregnant women
Clinical presentation
• Asymptomatic• Symptomatic
- Cystitis - Pyelonephritis
Risks
- Low birth weight baby- Low gestational age (<37 weeks) and Prematurity - Neonatal mortality
EAU Guidelines 2006
Recommended treatment regimens for asymptomatic
bacteriuria and cystitis in pregnancy Antibiotic Comments
Nitrofurantoin monohydrate / macrocrystals Avoid in G6PD deficiency 100 mg q12 h, 3–5 days
Amoxicillin Increasing resistance 500 mg q8 h, 3–5 days
Co-amoxicillin/clavulanate 500 mg q12 h, 3–5 days
Cephalexin 500 mg q8 h, 3–5 days Increasing resistance
Fosfomycin 3 g Single dose
Trimethoprim–sulfamethoxazole Avoid trimethoprim in q12 h, 3–5 days first trimester/term and sulfamethoxazole in third trimester/term
EAU Guidelines 2010
Recommended treatment regimens for pyelonephitis in pregnancy
Ceftriaxone 1–2 g IV or IM q24 h Aztreonam 1 g IV q8–12 h Piperacillin–tazobactam 3.375–4.5 g IV q6 h Cefepime 1 g IV q12 h Imipenem–cilastatin 500 mg IV q6 h Ampicillin 2 g IV q6 h + gentamicin 3–5 mg/kg/day IV in 3
divided doses
Outpatient management with appropriate antibiotics should be considered provided symptoms are mild and close follow-up is feasible
UTI in DiabetesUTI in Diabetes
Diabetes
Prevalence of UTI is 26% in women with diabetescompared with 6% in those without diabetes
Clinical presentation
• Asymptomatic• Symptomatic
- Cystitis - Pyelonephritis
Risks
Upper tract involvement in diabetes (pyelonephritis) is 5-fold more frequent than in non diabetics and can lead to serious complications like:
• Renal and perinephric abscess• Papillary necrosis
Int J Anti Agents 2000;15: 247-256
Diabetes
Causative organisms
E.Coli - 75%KlebsiellaEnterobacterS.faecalisFungi
Int J Anti Agents 2008;31S:S54-S57
Asymptomatic: Screening and treatment not warranted
Treatment for UTI in diabetic patients
Symptomatic:
• Long term antibiotics (7-14 days)
- Amoxicillin- Nitrofurantoin-TMP/SMX- Ciprofloxacin
• Choice of antimicrobials is similar in diabetic and non diabetics
• Commonly prescribed antibiotics
• TMP/SMX is not a good first choice as in addition to high resistance it can lead to hypoglycemia
Int J Anti Agents 2008;31S:S54-S57
Paediatric UTIPaediatric UTI
UTI in Children
Incidence of pediatric UTI
Pediatr Clin N Am 2006;53:379-400
Age (Y)Age (Y) Female (%)Female (%) Male (%)Male (%)
< 1< 1 0.70.7 2.72.7
1- 51- 5 0.9-1.40.9-1.4 0.1- 0.20.1- 0.2
6-166-16 0.7- 2.30.7- 2.3 0.04- 0.20.04- 0.2
Risk factors for pediatric UTI
• Neonate /Infant
• Urinary tract anomalies (Vesicoureteral reflux)
• Functional abnormalities (Neurogenic bladder) • Immunocompromised states
Pediatr Clin N Am 2006;53:379-400
Clinical presentation
Pediatric UTI
• Asymptomatic
• Symptomatic- Cystitis - Pyelonephritis
Risks
• Poor renal growth
• Recurrent pyelonephritis• Hypertension• End Stage Renal Disease (ESRD)
Pediatr Clin N Am 2006;53:379-400
Classification of pediatric UTI
Urinary Tract Infection
First Infection Recurrent Infection
Unresolved Bacteriuria
BacterialPersistance
Reinfection
Pediatr Clin N Am 2006;53:379-400
Classification of pediatric UTI
Severe UTI Simple UTI
Fever ≥ 39°CFever ≥ 39°C Mild pyrexiaMild pyrexia
Persistent vomitingPersistent vomiting Good fluid intakeGood fluid intake
Serious dehydrationSerious dehydration Slight dehydrationSlight dehydration
EAU Guidelines 2006
Diagnosis of pediatric UTI
Physical Examination +
Urinalysis/Urine culture
> 2 UTI episodes in girls
> 1 UTI episodes in boys
Imaging tests
EAU Guidelines 2006
Treatment of pediatric UTI
Severe UTI Simple UTI
Parental therapy until afebrile• Adequate hydration• Cephalosporins (3rd generation)• Amoxycillin/clavulanate if cocci are present
Oral therapyParental single-dose therapy (only in case of doubtful compliance)• Cephalosporins (3rd generation)• Gentamicin
Oral therapy to complete 10-14 days of treatment
Oral therapy to complete 5-7 days of treatment
EAU Guidelines 2006
Oral antimicrobials for pediatric UTI
Drug Dose (mg/kg/d) Frequency
CephalexinCephalexin 25-5025-50 q 6 hq 6 h
CefaclorCefaclor 2020 q 8 hq 8 h
CefiximeCefixime 88 q 12-24 hq 12-24 h
CefadroxilCefadroxil 3030 q 12-24 hq 12-24 h
NitrofurantoinNitrofurantoin 5-75-7 q 6 hq 6 h
AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h
AmoxicillinAmoxicillin 20-4020-40 q 8 hq 8 h
Pediatr Clin N Am 2006;53:379-400
Drug Dose (mg/kg/d) Frequency
CefazolinCefazolin 25-5025-50 q 6-8 hq 6-8 h
CefotaximeCefotaxime 50-18050-180 q 4-8 hq 4-8 h
CeftriaxoneCeftriaxone 50-7550-75 q 12-24 hq 12-24 h
CeftriazidimeCeftriazidime 90-15090-150 q 8-12 hq 8-12 h
CefepimeCefepime 100100 q 12 hq 12 h
AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h
GentamicinGentamicin 7.57.5 q 8 hq 8 h
Parenteral antimicrobials for pediatric UTI
Pediatr Clin N Am 2006;53:379-400
Antibiotic prophylaxis for Pediatric UTI
If there is an increased risk of UTI due to congenital abnormalities, low dose
prophylaxis is recommended
Drug Daily dosage (mg/kg/d)
Age limitation
CephalexinCephalexin 2-32-3 NoneNone
NitrofurantoinNitrofurantoin 1-21-2 >1 month>1 month
TMP-SMXTMP-SMX 1-21-2 >2 month>2 month
Pediatr Clin N Am 2006;53:379-400
Catheter Associated Urinary Tract Infections (CAUTI)
Catheter Associated Urinary Tract Infections (CAUTI)
The most common nosocomial infection ( 40 %) Causes bacteremia in 2-4 % of patients Risk factors Increasing duration of use Female sex Absence of antibiotics Disconnection of catheter-collecting tube junction
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
CAUTI – Pathogenesis
Two routes of entry-
• Periurethral
Common in femalesBacteria from rectal flora – Ecoli
• Intraluminal
Common in men Pseudomonas, Proteus etc
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
Intraluminal Route : Pathogenesis
BACTERIA
Attached to inner surface of catheter
Growing within urine itself
BIOFILM Planktonic growth
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
Biofilm Formation
Bacteria attached to inner surface of catheter
Sheets of organisms coat cather
Secrete extracellular matrix of bacterial glycocalyces
Tamm-Horsfall protein and urinary salts are incorporated in biofilm growth
Encrustation of catheter & catheter obstruction
Psudomonas are highly associated with propensity to form biofilm.
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S
BIOFILM FORMATION BIOFILM FORMATION
PLANKTONIC BACTERIAPLANKTONIC BACTERIA
ATTACHMENTATTACHMENT
MICROCOLONIESMICROCOLONIES
BIOFILM COMMUNITYBIOFILM COMMUNITY
Arch Intern Med / Vol.164,Apr 26,2004Arch Intern Med / Vol.164,Apr 26,2004
Decreased susceptibility to antibioticsDecreased susceptibility to antibiotics
• Physical impairment of diffusion of antibiotic agentPhysical impairment of diffusion of antibiotic agent• Trapping of antibiotic within matrix Trapping of antibiotic within matrix • Increased resistance rateIncreased resistance rate
Misleading microbiological laboratory resultMisleading microbiological laboratory result
Lacking of intrinsic defense systemLacking of intrinsic defense system
Clinical ImplicationClinical Implication
Arch Intern Med / Vol.164,Apr 26,2004Arch Intern Med / Vol.164,Apr 26,2004
The duration of catheterisation should be minimal
Prophylactic antibiotics and Chronic antibiotic suppressive therapy is generally not recommended
PreventionPrevention
EAU Guidelines 2010
Treatment for CAUTITreatment for CAUTI
• In case of symptomatic CAUTI, replace or remove the catheter before starting antimicrobial therapy if the indwelling catheter has been in place for > 7 days
• For empirical therapy, broad-spectrum antibiotics should be given based on local susceptibility patterns
• After culture results are available, antibiotic therapy has to be adjusted according to sensitivities of the pathogens
EAU Guidelines 2010
ProstatitisProstatitis
Most common urological diagnosis in men < 50 Most common urological diagnosis in men < 50 years and the third most common > 50 yearsyears and the third most common > 50 years
10% of men have prostatitis like symptoms10% of men have prostatitis like symptoms Life time probability > 25%Life time probability > 25% Rates are similar in Asia, USA and EuropeRates are similar in Asia, USA and Europe
Prostatitis : How big is the problem?Prostatitis : How big is the problem?
Diagnosis: Quantitative segmental bacterial Diagnosis: Quantitative segmental bacterial localization culture (Meares and Stamey)localization culture (Meares and Stamey)
NIH Classification of ProstatitisNIH Classification of Prostatitis
CasesCases (%)(%)
Mid stream Mid stream Urine sepcimenUrine sepcimenWBC WBC CultureCulture
Prostatic Prostatic specimen (EPS specimen (EPS or VB3)or VB3)WBC WBC CultureCulture
ABP (I)ABP (I) < 1< 1 ++ +++ + ++ + ++ +
CBP(II)CBP(II) 5-105-10 + ++ + + ++ +
CP/CPPS(III)CP/CPPS(III)Inflammatory (IIIA)Inflammatory (IIIA)Non Non inflammatory(IIIB)inflammatory(IIIB)
80-9080-90- -- -- -- -
+ -+ -- -- -
AIP AIP (asymptomatic (asymptomatic inflammatory inflammatory prostatitis)prostatitis)
1010 + -+ - - -- -
Which antibiotics?Which antibiotics?Prerequisites for use of antibiotics for CBPPrerequisites for use of antibiotics for CBP
• Active against expected pathogens
• Effective penetration into the prostatic tissue
• Well tolerated – prolonged therapy (up to 12 weeks)
• Convenient to take
Pathogens causing CBPPathogens causing CBP
Generally acceptedGenerally accepted
Escherichia coli Escherichia coli (50-80%)(50-80%) Klebsiella pneumoniaeKlebsiella pneumoniae Proteus miribalisProteus miribalis Pseudomonas Pseudomonas
aeruginosaaeruginosa Enterococcus faecalisEnterococcus faecalis
Potential Potential
Staphylococcus Staphylococcus saprophyticussaprophyticus
Staphylococcus aureusStaphylococcus aureus Staphylococcus Staphylococcus
epidermidisepidermidis StreptococcusStreptococcus Mycoplasma genitaliumMycoplasma genitalium Ureaplasma urealyticumUreaplasma urealyticum Chlamydia trachomatisChlamydia trachomatis
Campbells Urology, 9th edition
Treatment Treatment Chronic Bacterial ProstatitisChronic Bacterial Prostatitis
• favourable pharmacokinetic properties • excellent penetration in prostatic tissue• antibacterial activity against gram negative
pathogens, including Pseudomonas aeruginosa as well as gram positive pathogens
• good safety profile
EAU Guidelines 2010
Eur Urol Suppl 2007;6(2):72
Fluoroquinolones such as ciprofloxacin, levofloxacinand prulifloxacin may be considered as drugs of choicebecause of their:
Prulifloxacin 600 mg Vs Prulifloxacin 600 mg Vs Levofloxacin 500 mg in CBPLevofloxacin 500 mg in CBP
At 2 weeks there was a At 2 weeks there was a greater reduction in greater reduction in symptom scoressymptom scores
At 6 months 5 patients on At 6 months 5 patients on Prulifloxacin had a positive Prulifloxacin had a positive Meares-Stamey test Vs 11 Meares-Stamey test Vs 11 in the levofloxacin groupin the levofloxacin group
Well toleratedWell tolerated
N =96, 4 weeks treatment
Prulifloxacin is as effective and safe as levofloxacin In the treatment of CBPWith prulifloxacin there was trend to an earlier resolution of symptoms.
Eur Urol Suppl 2007;6(2):72
Highlights
• UTI is the common infection occurring in young women
• The most common presentation in young non-pregnant women is acute uncomplicated cystitis
• The recommended treatment for acute uncomplicated cystitis Is short course with antimicrobials like:
- Fosfomycin - Nitrofurantoin - TMP/SMX
• The most common pathogen causing UTI is E.coli
Highlights
• Choice of antibiotics should take into account not only the spectrum of activity but also resistance• E.Coli has highest susceptibility and least resistance for nitrofurantoin as compared to other commonly used antimicrobials
• Nitrofurantoin has maintained its place in the management of Uncomplicated cystitis due to highest susceptibility and least resistance
• The newer formulation of nitrofurantoin (Nitrofurantoin monohydrate/macrocrystals) offers the advantage of better GI tolerability and BID dosing, which improves the compliance
Highlights
• One year prophylaxis with nitrofurantoin significantly reduces the no of symptomatic episodes
• The antimicrobials used for prophylaxis are: Fluoroquinolones, nitrofurantoin,TMP/SMX, cephalosporins etc.
• Recurrent UTI can be managed by offerring long term prophylaxis or post coital prophylaxis
• A major concern in the treatment of UTI is recurrence and one in four women will develop recurrence
Highlights
• Fluroquinolones may be considered for empiric therapy of complicated UTI due to their broad spectrum antibacterial activity and good tissue penetration
• The treatment duration for the symptomatic UTI in pregnant women should be 10-14 days
• Asymptomatic bacteriuria in pregnant women should be treated
• The choice of antimicrobials in diabetic patients is similar to non diabetics but the duration should be 10-14 days
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