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 |
| | |
|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 |
| | |
|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 |
| | |
|(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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