Pharmacotherapy of __Urinary Tract Infections______



Pharmacotherapy of __Urinary Tract Infections______

Stefanie Martin, PharmD Candidate 2007

|Epidemiology |Varies with age and sex. |

| |Newborns < 6mo – prevalence 1% (mostly males) |

| |Age 1-5 – female prevalence 4.5%, male prevalence 0.5% |

| |Preschool age – males |

| |Grade school – puberty – prevalence 1% |

| |After puberty – prevalence 4% in females |

| |25% of women – lifetime prevalence (men < 0.1%) |

| |Elderly – equal |

|Disease State |Presence of microorganisms in the urinary tract that cannot be accounted for by contamination. This infection may be just the presence of |

|Definition |bacteria without symptoms of an infection, or can be accompanied by symptoms of infection. |

| |Cystitis or lower urinary tract infection involve the bladder. |

| |Urethritis involves infection of the urethra. |

| |Prostatitis involves the infection of the prostate. |

| |Pyelonephritis is an infection of the kidney and is also called an upper urinary tract infection. |

| |Urinary tract infections can also be classified as being complicated and uncomplicated. |

| |Uncomplicated urinary tract infections involve individuals who do not have functional/structural abnormalities of the urinary tract |

| |(generally women aged 15-45 years old). |

| |Complicated UTIs evolve from a lesion in the urinary tract (abnormality, catheter, stone, BPH, etc.) and men |

|Patho-physiology |Uncomplicated UTI: |

| |Bacteria typically arise from normal bowel flora. |

| |85% of uncomplicated UTIs are caused by e. coli. |

| |5-15% - staphylococcus saphrophyticus |

| |Klebsiella pneumoniae |

| |Proteus Spp. |

| |Pseudomonas aeruginosa |

| |Enterococcus spp. |

| |Complicated UTI: |

| |E. coli < 50% |

| |Proteus spp. |

| |K. pneumoniae |

| |Enterobacter spp |

| |P. aeruginosa (25%) |

| |Staphylococci |

| |Enterococci – 2nd most common in hospitalized patients (25%) |

| |Vancomycin resistant E. faecalis and S. Faecium |

| |Candidia – common in critically ill, underlying malignancies, and long-term hospitalization. |

| |Route of Infection: |

| |Ascending – most common involving women. Bacteria infect urinary tract from fecal flora. |

| |Hematogenous (descending) – dissemination of organisms from a distant infection in the body. Uncommon |

| |Lymphatic – little evidence to support this theory. |

|Clinical Presentation |Signs and Symptoms: |

| |Lower UTI: dysuria, urgency, frequency, suprapubic heaviness, gross hematuria |

| |Upper UTI: flank pain, fever, nausea, vomiting, malaise, CVA tenderness |

| |Labs: |

| |Bacteriuria |

| |Pyuria (WBC < 10/mm3) |

| |Nitrate positive urine |

| |Leukocyte esterase- positive urine |

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|Risk Factors |Obstruction (BPH, urethrial stricture, stones, tumors, etc) – disrupts the natural flow of urine that flushes bacteria from the urethra |

| |Vesicoureteral reflex – condition in which urine is forced up into the ureters to the kidneys; results from a congenital abnormality or |

| |bladder overdistention |

| |Urinary catheterization |

| |Medical instrumentation |

| |Pregnancy |

| |Use of spermicides and diaphragms |

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|Diagnosis |Patient History (signs and symptoms) – unreliable for the diagnosis of UTI alone |

| |Isolation of a significant number of bacteria from the urine (microscopic examination) |

| |Urine culture |

| |Dipstick urinalysis for leukocyte esterase |

| |Dipstick test for nitrate |

| |Pyuria (WBC > 10/mm3) |

|Desired Therapeutic |Prevent and treat systemic consequences of infection |

|Outcomes* |Eradicate the living organism |

| |Prevent recurrence of infection |

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|*Reference of | |

|Guidelines Used | |

| |* DiPiro Pharmacotherapy |

|Treatment Options** |** see treatment options table |

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|(Non-drug and Drug | |

|Therapy – include all | |

|therapeutic | |

|classes/agents | |

|available and | |

|preferences per | |

|treatment guidelines) | |

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|**See Treatment Options| |

|Table | |

|Monitoring |Efficacy: signs and symptoms of infection, urine culture and sensitivity |

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|(Efficacy and Toxicity |Toxicity: ** See treatment options table |

|Parameters) | |

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