Urinary Tract Infection

 UTIs are defined by the presence of
micro organisms within the urinary tract
 Difficult to distinguish between
contamination, colonization or infection

150 million people per year become
infected
20% of women between ages 20-65
suffer one attack per year
Approximately 50% of women develop
a UTI at least once.
1%-6% of general practitioner visits are
for UTIs.

CHRONIC
 General loss of health
anaemia,hypertension.
 Chronic Pylonephritis-
Chronic hypertension
&renal failure.
 Pus cells (+)
 Significant bacteriuria
ACUTE
 Infection localized to
urethra and bladder.
 frequency, urgency,
dysuria, pain in perineum.
 +/- fever, chills,
leucocytosis
 Pus cells (+++)
 Urine culture (+)–
“significant bactertiuria”

 Urethritis- painful urination
and burning
 Cloudiness in urine
 Blood in urine
 Micro organism counts:
100,000/ml (traditional)
1000/ml of one type
100/ml of E.coli
 Cystitis- inflammation of the
bladder, but known to
patients as any UTI.
 Infection caused by
bacterial infection mainly E.
coli.
 Symptoms include painful,
burning, urgent urination
and WBC in urine.
 Women mainly get this
because of the shorter
urethra, which puts it closer
to the anus where E.coli is
found.

 Pyelonephritis-
 Acute infection of the
kidneys caused by
progressively
untreated cystitis
 Symptoms include
fever, loin pain,
increase in WBC, and
bacteraemia
 Can compromise
kidney function and
require IV antibiotics
 Chronic pyelonephritis-
caused by chronic
inflammation of renal and
tubular tissue with scarring
and shrinkage secondary
interstitial fibrosis.

Rectum vaginal intoritus
Bacteria
Urethra
Bladder

 95% of UTI are due to gram –ve bacilli.
-80% E.coli (commonest)
-15% Proteus
Klebsiella
Pseudomonas
 5% of UTI are due to gram +ve cocci
Enterococci
Staphylococci
Streptococci
 Mixed infections are likely to be present in
chronic cases, in diabetics, obstructive
uropathies, indwelling catheters

 Bacteriological examination of mid
stream urine.
 Diabetes mellitus must be ruled out.
 Men with UTI often have obstructive
lesions or a focus of infection in the
prostrate.

 BACTERIOSTATIC AGENT
Sulfonamides
Tetracycline
Nitrofurantoin
 URINARY ANTISEPTICS
Nalidixic acid
Methenamine mandelate
Nitrofurantoin
 BACTERICIDAL AGENTS
Cotrimoxazole
Ampicillin
Extended spect. Penicillin
Aminoglycosides
Fluroquinolones
Cephalosporins

 Effective against E.coli
 Ineffective in-chronic, complicated
cases or mixed infections
 Cheap, easily available, and effective
orally.
 Bacterial resistance major problem.
 DOC: Sulfisoxazole 2g initially 1g qid for
7-10 days
 Prerequisite-Alkaline urine, liberal fluid
intake.

 Rapid g.i. absorption, high urinary
concentration.
 Bacteriostatic against common pathogens.
 Pseudomonas, proteus resistant.
 Not recommended for acute UTI.
 For ‘Chronic suppressive therapy’—
50-100 mg /day for several wks.
 Mainly useful for resistant infections, mixed
infections, infections associated with
obstructive uropathy.

 Mandelic acid +methenamine
Formaldehyde (acid PH 5.5)
Active against g-ve pathogens & c.albicans
 Not effective in acute ,upper UTI,aginst
proteus & pseudomonas
 Dose:1 g qid

 Used as reserved drug for occasional cases
(esp. proteus resistant to other drugs)
 Dose: 1gm qid x 7-10 days

 Highly potent and cost effective
bactericidal combination used aginst
E.coli & proteus.
 Dose: Acute UTI-2 tab bd x 7-10 days
Chronic UTI-1 tab twice a wk.
 Contraindicated in pregnancy.
 Successful in recurrent UTI in men
(prostatic focus)
 Ineffective in renal insufficiency.

 Effective bactericidal to E.coli ,aerobacter.
 Proteus, pseudomonas resistant.
 Ineffective against penicillinase producing
staph. aureus.
 Safe in pregnancy
 Dose:.0.5 g qid x 7-10 days.
 Resistant strains of E.coli esp.. hospital
acquired has been found.

 CARBENICILLIN:
Useful in pseudomonas infection of urinary
Infection when combined with Gentamicin.
 PIPERACILLIN:
-Broad spectrum activity against g-ve org.
(pseudomonas areuginosa).
-Dose:4-8 g iv daily in divided doses.
Status – use should be limited to severe life
threatening infections.

 Gentamicin is the only aminoglycoside
used in UTI.
 Effective against E.coli,proteus,pseudo.
 Disadv.- parental use
renal toxicity
ototoxicity
 Reserved for complicated UTI

 Ideal agents and drug of choice.
 Useful in nosocomial pylonephritis,
complicated UTI.
 Present status: first line drug for all UTI.

 Valuable in infections resistant to other
antibiotics (E.coli, Proteus,Pseudomonas)
 Doc. –Klebsiella infections.
 Indicated in septicemic UTI.

1. Acute cases treatment immediate.
2. Chronic case treatment after investigations.
3. Drug must achieve adequate conc. In tissue
and lumen.
4. Drug may be cidal /static –former more
capable.

5. Doses should be adequate for adequate
period.
6. PH of urine should be maintained at level that
permit optimum antibacterial activity.
7. Urine culture, gram staining to confirm
diagnosis, AST to guide therapy.
8. Predisposing factors must be eradicated.

1.Acute complicated cystitis: 3 day regimen
Cotrimoxazole : 2 tab bd
Ampicillin : 250-500mg qid
Cephalexin :500mg qid
Trimethoprin :100mg bd
Norflox : 400mg bd
Ciproflox : 250mg bd

 7-14 days treatment :
Indications:
Failure of 3 day regimen
Symptomatic men
Recurrence both in men & women
Pregnant women
Children
Patients with renal disease

2.Cystitis :
Any drug to which org ,is sensitive.( listed above)
3. Chronic persistent infection :
Commonly occur with indwelling catheter.
Treatment: one of the drug from 7-14 days regimen.
4.Asymptomatic bacteruria : no treatment
5.Post coital cystitis: full coarse + 0.5% cetrimide cream.
6.Acute urethritis: Doxy 100mg bd X 7 days

1.Acute uncomplicated pylonephritis:
Drug regimen :
Cotrimoxazole /Gentamicin with/ without Ampicillin /
Cephalosporins
2.Complicated UTI :
Minimal symptoms- Cipro. 500mg bd
Severe illness :
(Inj. Cefotaxime 2g qid iv & Inj.Genta 5 mg/kg od iv) x7-14 days
3.Chronic Pylonephritis : choice of drug after AST
cause to be searched.

Urinary Tract Infection

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