Treatment of Urinary Tract Infection

Treatment of urinary tract
infections
Prof. Hanan Habib
Goal
To eradicate the offending organisms from the
urinary bladder tissue.
The main treatment of UTI is by antibiotics.
Choice of antibiotic depends on:
Whether infection is complicated or
uncomplicated.
Whether infection is primary or recurrent.
Type of patient : pregnant women ,children ,
hospitalized patients , diabetic patients
Bacterial count.
Presence of symptoms.
Uncomplicated UTI
Low-risk patient (woman) for recurrent
infection.
7-days antibiotic without urine test.
Cure rate 94%.
Choice of antibiotic depend on
susceptibility pattern ,include:
Amoxicillin ( with or without clavulanate)
Cephlosporins ( first or second generation)
TMP-SMX
Nitrofurantoin ( long term use)
Fluoroquinolone ( ciprofloxacin or norfloxacin)
(not for pregnant women or children) ,first
choice if other antibiotics are resistant.
Complicated Cystitis
Ciprofloxacin for 5-14 days is better choice
then others.
Relapsing infection
Caused by treatment failure or structural
abnormalities or abscesses.
Antibiotics used as initial infection
Treatment for 7-14 days.
Recurrent infections
Patients with two or more symptomatic UTIs
within 6 months or 3 or more over a year.
Need preventive therapy
Antibiotic taken as soon as symptoms develop.
If infection occurs less than twice a year, a clean
catch urine test should be taken for culture
and treated as initial attack for 3 days.
When to consult the doctor ?
If symptoms persist
A change in symptoms
Pregnant women
Three or more infections per year
Impaired immune system
Previous kidney infections
Structural abnormalities of urinary tract
H/O infection with resistant bacteria
Postcoital antibiotics
If recurrent UTI related to sexual activity, and
episodes recur more than 2 times within 6
months
A single preventive dose taken immediately
after intercourse
Antibiotics include: TMP-SMX, Cephalexin or
ciprofloxacin
Prophylactic antibiotics
Optional for patients who do not respond to
other measures.
Reduces recurrence by up to 95%
Low dose antibiotic taken continuously for 6
months or longer, it includes :
TMP-SMX, Nitrofurantoin, or Cephalexin
Antibiotic taken at bed time more effective.
Uncomplicated pyelonephritis
Patients with fever, chills and flank pain ,but they
are healthy non-pregnant not nauseous or
vomiting with no signs of kidney involvement.
Always collect urine for culture
Can be treated at home with oral antibiotics for
10-14 days with one of the followings:
Ciprofloxacin, Ceftriaxone , Aminoglycosides or
TMP-SMX.
First dose may be given by injection
Avoid Nirofurantoin
Continue-
A urine culture may be obtained if the patient
has persistent after 48-72 hrs or recurrent
symptoms.
Moderate to sever pyelonephritis
Patients need hospitalization
Antibiotic given by IV route for 3-5 days until
symptoms relieved for 24-48 hrs.
Ciprofloxacin or ceftriaxone for 10-14 days
If fever and back pain continue after 72 hrs of
antibiotic, imaging tests indicated to exclude
abscesses, obstruction or other abnormality.
Chronic pyelonephritis
Those patients need long-term antibiotic
treatment even during periods when they
have no symptoms.
Treatment of specific populations
Pregnant women
High risk for UTI and complications
Should be screened for UTI
Antibiotics during pregnancy include:
Amoxicillin, ampicillin, cephalosporins,and
nitrofurantoin.
Pregnant women should NOT take quinolones.
Drug safety During pregnancy
Avoid Ceftriaxone one day before delivery
Avoid nitrofurantoin and trimethoprim (FA)in
the first trimester can lead to birth defects
Avoid near term and hemolytic anemia in G6PD
deficiency(0.0004%)
Sulfonamides should be avoided in the last days
before delivery because they can increase the
level of unbound bilirubin in the neonate
Pregnant women with asymptomatic bacteriuria
( evidence of infection but no symptoms) have
30% risk for acute pyelonephritis in the
second or third trimester.
Screening and 3-5 days antibiotic needed.
For uncomplicated UTI, need 7-10 days
antibiotic treatment.
Diabetic patients
Have more frequent and more sever UTIs.
Treated for 7-14 days antibiotics even patients
with uncomplicated infections.
Urethritis in men
Require 7days regimen of Doxycycline.
A single dose Azithromycin may be effective but
not recommended to avoid spread to the
prostate gland.
Patients should also be tested for accompanying
STD.
Children with UTI
Usually treated with TMP-SMX or Cephalexin.
Sometimes given as IV.
Gentamicin may be recommended as resistance
to cephalexin is increasing.
Vesicoureteric reflux ( VUR)
Common in children with UTI
Can lead to pyelonephritis and kidney damage.
Long-term antibiotic + surgery used to correct
VUR and prevent infections.
Acute kidney infection : use Cefixime (Suprax)
or 2-4 days Gentamicin in a one daily dose.
Oral antibiotic then follows IV.
Management of catheter-induced UTI
Very common
Preventive measures important
Catheter should not be used unless absolutely
necessary and they should be removed as soon
as possible.
Intermittent use of catheters
If catheter required for long-periods ,it is best to
be used intermittently.
May be replaced every 2 weeks to reduce risk of
infection and irrigating bladder with
antibiotics between replacements
Daily hygiene and use of closed system to
prevent infection.
Catheter induced infections
Catheterized patients who develop UTI with
symptoms or at risk for sepsis should be
treated for each episode with antibiotics and
catheter should be removed, if possible.
Associated organisms are constantly changing.
May be multiple species of bacteria.
continue-
Antibiotic use for prophylaxis is rarely
recommended since high bacterial counts
present and patients do not develop
symptomatic UTI.
ANTIBIOTIC THERAPY HAS LITTLE BENEFIT IF
THE CATHETER IS TO REMAIN IN PLACE FOR
LONG PERIOD.

Treatment of Urinary Tract Infection

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