سمينار طب داخلي

هداوند فهيمه دكتر

 Uncomplicated urinary tract

infection

Hadavand fahimeh

Infectious disease specialist

Classification:

1) uncomplicated: cystitis and

pyelonephritis in women without

abnormal metabolic, anatomic

disease

2) Classification:

cystitis and pyelonephritis in men

children and women with

anatomical and metabolic disease

such as diabetes, neurologic

bladder

Microbiology:

E.coli 75-95% of episodes

Others: klebsiella pneumonia and gram

postive such as staphylococcus

suprophyticus, enterococcus faecalis,

streptococcus agalactiae

Uncomplicated:

Patient: healthy, ambulatory women

with no history of anatomical or

functional abnormality of the

urinary tract.

Clinical:

Cystitis: dysuria, with or without

frequency, urgency, suprapublic

pain or hematuria

Pyelonephritis:

fever, chills, flank pain, CVAT,

nausea, vomiting, with or without

symptoms of cystitis.

Dysuria is common with urethritis or

vaginitis. But cystitis is more likely

when symptons include frequency,

argency, or hematuria.

When the onst is sudden or severe.

Diagnosis:

on the basis of typical symptoms.

U/A and U/C is not indicated in

cystitis but recommended for

pyelonephritis

Assesment of pyuria and bacteruria

with dipstick

Pyuria: dipstick for leukocyte

esterase.

Bacteruria: dipstick for nitrites.

Sensivity: 75% specifity: 82%

Urine culture:105 CFU per milliliter

Antimicrobial regimen

First line therapy:

- nitrofurantion 5 days

- Tmp-smx 3 days

- Fofomycia 3g/S.D

- pivmecillinam 400 mg BD (3-7 days)

Side effects:

Nitrofuranstion: nausea, headache

Tmp-smx: urticaria, vomiting, photosensivity

Fosfomycin: diarrhea headache, vaginitis

Pivmecillinam: nausea, headache, diarrhea.

Second line therapy side effect Fluoroquinolones: 3days

insomnia, headache drowsiness

Betalactams (3-7 days) uriticaria (e.g. co-amoxi, cefaclor) rash, vomiting

Acute uncomplicated pyelonephritis: Fluroquinolones 5days Tmp-smx 14days Beta lactams 10-14 days

Recurrent cystitis

Relaps: time (one or two week after cystitis)

Treatment: board spcctrum AB. Such as

fluoroquinolone.

Reinfection: at least 1 month after cystitis

Treatment: first line short course regimen

Antimicrobial prophylaxis Three or more urinary tract

infection in the past 12 months. Or two or more in the past 6

months.

Follow up Cystitis and pyelonephritis is not

recommended but persistant hematuria or multiple early recurrences.

in pyelonephritis when fever 48 to 72 h after treatment or severe or worsening illness

Prevention of recurrent acute

uncomplicated cystitis

1) nonantimicrobial

2) antimicrobial

Nonantimicrobial

Behavioral:

No spermicide, urination before intercourse

Biologic:

Cranberry juice, topical estrogen.

Adhesion blocker (D-mannose)

Antimicrobial Self diagnosis and self treatment: u.c be

obtained periodically for confirme and susceptibilities

Antimicrobial prophylaxis. Postcoital: single dose Continuous: daily bed time dose: for six

month

Antimicrobial:

Nitrofurantion: 50-100 mg

Tmp-smx: 40mg and 200 mg

Tmp: 100 mg

Cephalexin:125-250

Thanks for your attension