Download to read offline
More Related Content
Similar to DRUGS USED IN UTI OR URINARY ANTISEPTICS
DRUGS USED IN UTI OR URINARY ANTISEPTICS
- 1. URINARY TRACT INFECTION(UTI) Dr.Stuti Singh Assistant Professor UNSASMC,JAUNPUR
- 2. URINARY ANTISEPTICS These areorally administered AMAs which attain antibacterial concentration only in urine, with no systemic antibacterial effect. They are concentrated in the kidney tubules, and are useful in lower urinary tract infection ((UTI). They have been called urinary antiseptics because this may be considered as a form of local therapy. Nitrofurantoin and methenamine are two such agents; infrequently used now.
- 3. URINARY TRACT INFECTION(UTI) Upper urinary tract infection It infects kidney and ureters. Symptoms - loin pain, fever Lower urinary tract infection Burning micturition (burning sensation while passing the urine), Increased frequency of micturition, Fever
- 4. Nitrofurantoin It isprimarily bacteriostatic, but may be cidal at higher concentrations and in acidic urine, because its activity is enhanced at lower pH. No cross resistance with any other Antimicrobial agents. It is mainly effective against E.coli. Many gram-negative bacteria except Ps. aeruginosa and proteus were susceptible.
- 5. Mechanism of action Nitrofurantoin entersbacterial cell Produces reactive intermediates Damages bacterial DNA Bacterial death
- 6. CONTRAINDICATIONS It is contraindicatedin patients with renal failure, neonates, and G6PD deficient patients.
- 7. ADVERSE EFFECTS gastrointestinal intolerance—nausea,epigastric pain and diarrhoea. Urine of patients taking nitrofurantoin turns dark brown on exposure to air
- 8. Methenamine (Hexamine) Itis inactive (prodrugs)as such; but decomposes slowly in acidic urine to release formaldehyde which inhibits all bacteria. This drug exerts no antimicrobial activity in blood and tissues. Acidic urine is essential for its action.
- 9. MECHANISM OF ACTIONOF METHENAMINE METHENAMINE (PRODRUGS) STOMACH (ENTERIC COATED) GET ABSORBED IN INTESTINE AND ENTER IN KIDNEY UNDER ACIDIC CONDITION (URINE IS ACIDIC) THE DRUGS GETS CONVERTED INTO A TOXIC COMPOUND FORMALDEHYDE. FORMALDEHYDE KILLS BACTERIA
- 10. Empirical antimicrobial regimensfor acute UTI (all given orally for 3–5 days)* 1. Ciprofloxacin 250–500 mg 12 hourly 2. Ofloxacin 200–400 mg 12 hourly 3. Cotrimoxazole 960 mg 12 hourly 4. Cephalexin 250–500 mg 6 hourly 5. Cefpodoxime proxetil 200 mg 12 hourly 6. Amoxicillin + clavulanic acid (500 + 125 mg) 8 hourly 7. Nitrofurantoin 50 mg 8 hourly or 100 mg 12 hourly × 5–7 days
- 11. Empirical antimicrobial regimensFor upper UTI (pyelonephritis) the same drugs may be given for 2 weeks. Nitrofurantoin is not suitable for pyelonephritis.
- 12. The status ofAMAs (other than urinary antiseptics) in urinary tract infections 1. Cotrimoxazole employed empirically in acute UTI without bacteriological data, because majority of urinary pathogens, including Chlamydia trachomatis, are covered by cotrimoxazole. It should not be used to treat UTI during pregnancy.
- 13. 2. Quinolones Thefirst generation FQs, especially ciprofloxacin and ofloxacin are highly effective and currently the most popular drugs, because of potent action against gram-negative bacilli and low cost. The FQs should not be given to pregnant women.
- 14. 3. Ampicillin/Amoxicillin Amoxicillin+ clavulanic acid is more frequently employed. Parenteral coamoxiclav is often combined with gentamicin for initial treatment of acute pyelonephritis
- 15. 4. Piperacillin/Ticarcillin used onlyin serious Pseudomonas infection
- 16. 5. Cephalosporins Usedespecially in women with nosocomial Klebsiella and Proteus infections.
- 17. 6. Gentamicin Itis very effective against most urinary pathogens including Pseudomonas In acute pyelonephritis gentamicin + parenteral amoxicillinclavulanate, may be initiated empirically before bacteriological report becomes available
- 18. Urinary pH inrelation to use of AMAs Certain AMAs act better in acidic urine, while others in alkaline urine ACIDIC ALKALINE pH immaterial Nitrofurantoin Cotrimoxazole Chloramphenicol Methenamine Aminoglycosides Ampicillin Tetracyclines (Gentamicin, etc.) Cloxacillin Cephalosporins Fluoroquinolones
- 19. Prophylaxis for urinarytract infection The most frequently used drugs for prophylaxis or long-term suppressive treatment of lower UTI are: • Cotrimoxazole 480 mg* OD P/O HS • Nitrofurantoin 100 mg* OD P/O HS • Norfloxacin 400 mg* OD P/O HS • Cephalexin 250 mg* OD P/O HS * All drugs are given once daily at bed time.
- 20.