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- 1. TOPIC: URINARY TRACT INFECTIONS GROUP# 11 (AREEBA,AYESHA,IQRA, NIDA,OMAMA,SAFIA,SH EEMA, USRA AND ZAHIDA) INDUSTRIAL PHARMACY 4TH YEAR PHARMACY EVENING ACKNOWLEDGED BY MA’AM MAHEEN NAFEES.
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- 4. HISTORY OF PRESENTINGILLNESS: • Dysurea • Urgency • Frequency • Lower back pain • No hematuria, hypogastric pain, supra pubic pain and Fever. • No consult & No medications.
- 5. PAST MEDICAL HISTORY: • UTI(early this year) • Treated, resolved. • No past surgeries & hospitalization • No hyertension, Diabetes, asthama. • Allergic to AMOXICILLIN.
- 6. FAMILY HISTORY: • Unremarkable family history PERSONAL-SOCIAL HISTORY: • Non smoker, non alcohol drinker • House wife OB-GYNE HISTORY: • LMP: FEB 11(Day 5 of mensturation) • 3-5 day duration, 28-30 day interval of mensturation.
- 7. CLINICAL IMPRESSION: • Clinically, acute uncomplicated cystitisis suspected in non pregnant women b/c of dysurea, frequency, gross hematuria with or without back pain. DIAGNOSTICS: • Light yellow • Turbit • Ph 7.0 • SG : 1.015 • RBCS : +3 • Protein : +1 • WBCS: +3 • Depithelial 3/hpf • Bacteria 251/hpf
- 8. INTRODUCTION • Symptomatic presenceof micro organisms within the urinary tract. i.e., kidney, ureters, bladder and urethra • Associated with inflammation of urinary tract.
- 9. • Upper urinarytract infection: The upper urinary tract consists of the kidneys and ureters and infection to any of these is termed as upper urinary tract infections. • Lower urinary tract infection: The lower urinary tract consists of the bladder and urethra and infection to any of these is termed as lower urinary tract infections
- 10. • MOST COMMONORGANISMS WHICH CAUSE UTIs • Escherichia coli • Enterobacter • Pseudomas • Serratia • Staphylococcus saprophyticus • Candida
- 11. OVERVIEW OF UTITO AGE: - The prevalence of urinary tract infections varies with age and sex.
- 12. ASYMPTOMATIC BACTERIURIA • Asymptomaticbacteriuria denotes significant bacteriuria. • If bacteria were isolated in quantitative counts of ≥105 CFU/mL in a voided urine specimen from asymptomatic patients. • Common in pregnancy, patient with indwelling catheter, and Diabetes Mellitus.
- 13. ACUTE PYELONEPHRITIS: • AcutePyelonephritis is an inflammation of the kidney tissue, and renal pelvis. It is commonly caused by bacterial infection that has spread up the urinary tract or travelled through the bloodstream to the kidneys.
- 14. CHRONIC PYELONEPHRITIS: (Ayesha Malik) • Chronicpyelonephritis is characterized by renal inflammation and fibrosis induced by recurrent or persistent renal infection or other causes of urinary tract obstruction. It is associated with progressive renal scarring, which can lead
- 15. Factors that mayaffect the pathogenesis of chronic pyelonephritis • Pregnancy, which may lead to progression of renal injury with loss of renal function • Genetic factors • Bacterial virulence factors • Neurogenic bladder dysfunction.
- 16. UPPER VS LOWERURINARY TRACT INFECTIONS: • Infections of the urethra (urethritis) and the bladder (cystitis) are referred to as lower urinary tract infections. • Involvement of the ureters and the kidneys (pyelonephritis) is referred to as upper urinary tract infections. • Urethritis: Inflammation of the urethra • Cystitis: Inflammation to urinary
- 17. URETHRAL SYNDROME: • urethralsyndrome (also known as frequency- dysuria syndrome) • Urethral syndrome is characterized by urinary frequency, dysuria, and suprapubic discomfort without any objective finding of urological abnormalities. It is also characterized by urinary frequency that is typically worse during the day than during the night.
- 18. PATHOGENESIS: • 4 routesof bacterial entry to urinary tract. • Ascending infection • Blood borne spread • Lymphatogenous spread • Direct extension from other organs
- 19. 1. Ascending Infection: •Most common route. • Organisms ascend through urethra into bladder
- 20. 2. Hematogenous spread: •Blood borne spread to kidneys. • Occurs in bacteraemia mostly S.aureus 3. Lymphatogenous spread: • Men- through rectal and colonic lymphatic vessels to prostrate and bladder. • Women- through periuterine lymphatics to urinary tract.
- 21. 4. Direct extensionfrom other organs: • Pelvic inflammatory diseases • Genito-urinary tract fistulas
- 22. MANIFESTATIO N OF UTI: 1.chronic pyelonephritis: •Chronic pyelonephritis is often asymptomatic. There may be features of acute or recurrent infection. • Fever • Malaise • Loin pain • Nausea • Vomiting • Dysuria • Hypertension • Features of CKD • Anemia (in later stages) • Itching
- 23. 2.ACUTE PYELONEPHRITIS: • Classicsymptoms of pyelonephritis include a sudden onset of chills, fever (body temperature of 38 °C or greater), and unilateral or bilateral flank pain with costovertebral tenderness. In addition, gastrointestinal symptoms can be also present in acute pyelonephritis – namely abdominal pain, diarrhea, nausea and vomiting. • Children younger than two years of age may only present with a high fever without symptoms related to the urinary tract. Other findings include poor feeding, abdominal pain and lethargy.
- 24. 3.CYSTITIS: Cystitis signs andsymptoms often include: • A strong, persistent urge to urinate(urgency) • A burning sensation when urinating • Passing frequent, small amounts of urine • Blood in the urine (hematuria) • Passing cloudy or strong-smelling urine • Pelvic discomfort • A feeling of pressure in the lower abdomen • Low-grade fever • Pyuria (pus in urine)
- 25. 4.URETHRITIS: • There isulceration of the urethra. • The presence of itching. • The presence of pus early micturition. • Dysuria (painful urination ) • Difficulty starting urination, less heavy and stopped while micturition (prostatism). • Pain in the lower abdomen (supra pubic). • Mucosal reddening and edema.
- 26. UTI DIAGNOSIS : Microscopicexamination of urine Urinalysis Urine culture Imaging Techniques CT scan and MRI Laboratory examination Uncontaiminated , midstream sample is used Methods for urine collection 1.Stick on bags 2.cathaterization 3.Superapubic aspiration (SPA) gold standard for urine collection
- 27. • LABORATORY FINDINGS Abnormalfindings • pH – Alkaline ( increases) • Appearance – cloudy • Color - deep amber • Odor – foul smelling • Blood – maybe present • Leukocyte esterase - present • WBC- present • Bacteria- present
- 28. • NormalFindings • pH- 4.6 – 8.0 • Appearance- clear • Color – pale to amber yellow • Odor – aromatic • Blood – none • Leukocyte esterase – none • WBC- absent • Bacteria- absent URINALYSIS : • Presence of pus, white blood cells, red blood cells • Bacterial count > 105 /ml – significant bacteriuria • Leukocyte esterase dipstick test – WBC in urine • Nitrite dipstick test- pink colour
- 29. URINE CULTURE : Forpyelonephritis • Not a rapid diagnostic tool • >105 bacteria /ml • Differential leukocyte count- increased neutrophils Diagnostic tests for adults with recurrent UTI • Intravenous pyelography /
- 30. Urethral syndrom: (omama) •1000 mg of calcium carbonate or calcium citrate • * 500 mg of magnesium oxide or magnesium malate or magnesium citrate • * 1000 mg of potassium bicarbonate or potassium citrate • Pharmacologic therapy is discussed in detail in Medication. Medications include the following: • Hormone replacement • Anesthetics • Antispasmodics • Tricyclic antidepressants (TCAs) • Muscle relaxants • Alpha-blockers
- 31. Chronic pyelonephritis : •The penicillins (amoxicillin) and first-generation cephalosporins are the drugs of choice because of good activity against gram-negative rods and good oral bioavailability. In infants, the choice of antibiotics is either amoxicillin or a first- generation cephalosporin. In patients aged 3-6 months, therapy can be changed to sulfamethoxazole or nitrofurantoin. Older children and adults may be treated with trimethoprim-sulfamethoxazole.
- 32. UPPER UTI TREATMENT: •A high fluid intake is essential. Alkaline substances, such as citrates, taken in water might improve symptoms. • By making the urine more alkaline, they make the environment more hostile to bacterial growth and improve the results of antibiotic therapy. ephalosporins, nitrofurantoin and norfloxacin are the first choices in patients with signs of upper UTI or kidney infection. People with upper tract infections are usually treated with a 10 to 14 day course of antibiotic therapy. Those with severe upper tract infections may require hospital treatment with antibiotics given through a vein (intravenously). This is especially true if nausea, vomiting and fever
- 33. TREATMENT: • Uti isa problem of all age group and one of the most common reason for prescrbing antibiotics in which E.COLI is the most frequent pathogen . • Treatment for uncomplicated lower UTI: • Best therapy would seems to be choice between trimethoprim and oral cephalosporin such as cefalxin, co-amoxiclav, or nitrofurantoin .
- 34. ANTIBIOTIC DOSE SIDEEFFECTS CONTRAINDICATI ON Duration of treatment CO- amoxiclav 375-625 mg TID Nausea , allergy Penicillin hypersentivity Course of 7-10 days in men Course of 3 days in women Course of 7-10 days in children also Cefalexin 250-500mg QID Nausea , allergy Penicillin hypersentivity Trimethoprim 200mg twice a day Pruritis, allergy porphyyrai Nitrofurantoin 50mg four times a day Neuropathy Ranal failure Ciprofloxacin 100-50mg twice a day Rash Pregnancy, children
- 35. Antibiotic Dose Sideeffects Containdications Dyration of treatment Cefuroxime 750mg TID Nausea , allergy Prophyria Continue for 10- 14 days Ceftazidime 1 g TID Nausea , allergy Prophyria Co- amoxiclav 1.2 g TID Nausea , diarrhea Penicillin hypersentivity Gentamicin 80-120mgTID ototoxicity pregnancy Ciprofloxacin 200-400mg twice a day Tendinitis Pregnancy, children TREATMENT OF ACUTE pyelonephritis: Patient are severely ill in this condition so we start parentral antibiotic when the patient is improving the route of administration will be switched to oral therapy.
- 36. ASYMPTOMATIC BACTERIURIA: • Itmay or may not need treatment, it depends pon the circumstances of the individual case. It should be treated in pregnant women and children. • Oral antibiotics should be used (when tolerated) instead of parenteral antibiotics to manage UTI in children. hat short courses of antibiotics (two to five days) may be as effective as longer courses (seven to 14 days). Erythromycin 250 to 500 mg four times daily Nitrofurantoin 50 to 100 mg four times daily Sulfisoxazol 1 g four times daily Amoxicillin-clavulanic acid 250 mg four times daily
- 37. TREATMENT: • Uti isa problem of all age group and one of the most common reason for prescrbing antibiotics in which E.COLI is the most frequent pathogen . • Treatment for uncomplicated lower UTI: • Best therapy would seems to be choice between trimethoprim and oral cephalosporin such as cefalxin, co-amoxiclav, or nitrofurantoin . TREATMENT OF ACUTE pyelonephritis: • Patient are severely ill in this condition so we start parenteral antibiotic when the patient is improving the route of administration will be
- 38. Risk factor : Femaleanatomy: • A woman has a shorter urethra than a man does, which shortens the distance that bacteria must travel to reach the bladder. Sexual activity: • Sexually active women tend to have more UTIs than do women who aren't sexually active. Having a new sexual partner also increases your risk.
- 39. • Certain typesof birth control: Menopause: • After menopause, a decline in circulating estrogen causes changes in the urinary tract that make you more vulnerable to infection.
- 40. Prevention from UTI: •Wipe from front to back: • Doing so after urinating and after a bowel movement helps prevent bacteria in the anal region from spreading to the vagina and urethra.
- 41. Clothing: • Do notwear tight-fitting undergarments made of nonbreathing materials. Diet: • Drink more water. Start with 1 extra glass with each meal. Cranberry juice and cranberry pills have unproven benefit in reducing urinary infections. They appear to be most effective in younger women.
- 42. ACTIVITIES: • take specialprecautions after sexual activity; such activity may also increase risk because it can introduce bacteria into the bladder area. Medications : • An estrogen vaginal cream may help increase resistance to bladder infections. An estrogen cream for the vagina may be suggested for women after menopause even
- 43. Sterilizing Washcloths forHome Use: • Sterilizing washcloths for washing and personal hygiene to help prevent recurrent UTIs may be recommended. • Wash the washcloths with hot water and soap in a clothes washer. If a clothes washer is unavailable, use soap and hot water in the sink.
- 44.
- 45. WHY? •According to Age(young), Non- pregnant, symptoms (dysurea, urgency frequency) and lab values (positive protein, RBCs & Bacteria) we conclude that the patient was suffering from acute uncomplicated cystitis. •Cystitis is an infection of the bladder. This is most common in women, and less common in men. Now, we can also differentiate cystitis, from uncomplicated cystitis and we from complicated cystitis.
- 46. • Now, complicatedcystitis is infection of the urinary bladder, patient is also pregnant, a male, has a foley catheter, or has some kind of structural abnormality with their kidneys that makes it more difficult to get rid of the infection. May have diabetes or other type of immunosuppression that will make eradicating this disease process a little more difficult. • These patients require a few extra things: a longer duration of therapy and closer monitoring because there can be more complications and are more prone to develop into pyelonephritis.
- 48. UTI IN LIGHTOF NEW RESEARCHES (safia) 1.Antibiotic Prophylaxis and Recurrent Urinary Tract Infection in Children • Long-term, low-dose trimethoprim– sulfamethoxazole was associated with a decreased number of urinary tract infections in predisposed children. 2.Prevalence of urinary tract infection in febrile infants • Urinary tract infection (UTI), a relatively common cause of fever in infancy, usually consists of pyelonephritis and may cause
- 49. 3.Guidelines for managementof children with urinary tract infection and vesico- ureteric reflux. • The aim is to limit renal damage and future complications, with minimal discomfort to the child. The recommendations include increased attention to bladder dysfunction, shortening of the time of antibacterial prophylaxis and focus on renal development and function rather than on reflux.
- 50. REFERENCE: https://www.slideshare.net/bindupulugurtha/urinary-tract- infections-11817974 http://www.differencebetween.net/science/health/difference- between-upper-and-lower-urinary-tract-infection/ http://www.columbia.edu/itc/hs/medical/pathophys/id/2008/utinote s.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/pmc2875701/ clinical phramcy and therapeutics, roger walker and cate whittlesea, fifth edition http://www.aafp.org/afp/2005/1215/p2483.html http://www.slideshare.net/binduplugurtha/urinary-tract-infection- 11817974 https://www.slideshare.net/mobile/joanvijetha/pre-formulation https://www.slideshare.net/mobile/pallavikurra/parentrals the philippine clinical practice guidelines on diagnosis and management of urinary tract infections in adults,2004 harrison’s principles of internal medicine, 16th edition