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Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Chapter 89
Drug Therapy of Urinary Tract Infections
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Urinary Tract Infections (UTIs)
Second most common infection Sexually active young women
25% to 35% develop at least one UTI a year Older adult women in nursing homes
30% to 50% have bacteria at any given time Less frequent in males
Occurrence likely associated with complications (for example, septicemia, pyelonephritis)
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Urinary Tract Infections (UTIs)
Complicated and uncomplicated UTIs Upper (kidney)
Acute pyelonephritis Acute bacterial prostatitis
Lower (bladder and urethra) Acute cystitis Acute urethral syndrome
Recurrent urinary tract infections
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Organisms That Cause UTIs
80% of uncomplicated, community-acquired UTIs: Escherichia coli
Hospital-acquired UTIs: Frequently caused by Klebsiella, Proteus, Enterobacter, Pseudomonas, staphylococci, enterococci, and E. coli
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Drug Therapy of UTIs
Trimethoprim/sulfamethoxazole (TMP/SMZ) and nitrofurantoin: Frequently the treatment of choice for oral therapy of UTIs
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Acute Cystitis
Symptoms Dysuria, urinary urgency, urinary frequency,
suprapubic discomfort, pyuria, bacteriuria (subclinical pyelonephritis)
Single-dose therapy Short-course therapy (3 days) Conventional therapy (7 days)
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Acute Uncomplicated Pyelonephritis
Common in young children, older adults, women of childbearing age Fever, chills, severe flank pain, dysuria,
urinary frequency, urinary urgency, pyuria, and usually bacteriuria
E. coli: Causative organism in 90% of community-acquired infections Mild pyelonephritis: Moderate infection
(treatment at home with oral antibiotics) Severe pyelonephritis: Requires
hospitalization and IV antibiotics
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Complicated UTI
Female and male patients with structural or functional abnormality of the urinary tract Prostatic hyperplasia, renal calculi,
nephrocalcinosis, renal or bladder tumors, ureteric stricture, or indwelling catheter
Symptoms range from mild to severe Patient may develop systemic illness
manifesting as fever, bacteremia, and septic shock
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Recurrent UTI
Relapse 20% recolonization with the original
infecting organism Suggests structural abnormality of urinary
tract, involvement of kidneys, or chronic bacterial prostatitis
Reinfection 80% of recurrent UTIs in females Usually involves lower urinary tract and may
be related to sexual intercourse
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Acute Bacterial Prostatitis
Inflammation of the prostate caused by local bacterial infection High fever, chills, malaise, myalgia,
localized pain, dysuria, nocturia, urinary urgency, urinary frequency, urinary retention
80% of cases caused by E. coli Frequently associated with indwelling
urethral catheter, urethral instrumentation, transurethral prostatic resection
Responds well to antimicrobial therapy
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Urinary Tract Antiseptics
Nitrofurantoin Methenamine
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Nitrofurantoin [Furadantin, Macrodantin, Macrobid]
Low concentrations: Bacteriostatic High concentrations: Bactericidal Uses: Lower UTIs, prophylaxis, recurrent
lower UTIs
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Nitrofurantoin [Furadantin]
Adverse effects Gastrointestinal effects Pulmonary reactions: Acute and subacute Hematologic effects Peripheral neuropathy: Demyelinization and
nerve degeneration can occur and may be irreversible
Hepatotoxicity Birth defects Other
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Methenamine [Mandelamine]
Decomposes into ammonia and formaldehyde, which denature bacterial proteins
Therapeutic uses Chronic lower UTIs (TMP/SMZ is the
preferred drug) Adverse effects
Relatively safe and generally well tolerated Contraindicated in renal and liver failure
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Methenamine [Mandelamine]
Drug interactions Urinary alkalinizers Sulfonamides
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Which patient does the nurse identify as most likely to need treatment with trimethoprim/sulfamethoxazole [Bactrim] for a period of 6 months?
A. A female patient with acute pyelonephritis B. A male patient with acute prostatitis C. A female patient with recurring acute urinary tract
infections D. A male patient with acute cystitis
Question 1
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Which patient would most likely need intravenous antibiotic therapy to treat a urinary tract infection?
A. A patient with an uncomplicated urinary tract infection caused by Escherichia coli
B. A patient with pyelonephritis with symptoms of high fever, chills, and severe flank pain
C. A patient with acute cystitis who complains of dysuria, frequency, and urgency
D. A patient with acute bacterial prostatitis with a mild fever, chills, and nocturia
Question 2
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Which drug does the nurse identify as a urinary tract antiseptic?
A. Ciprofloxacin B. Ceftriaxone C. Nitrofurantoin D. Ceftazidime
Question 3
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