CH 89 Treatment for UTI

Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 89

Drug Therapy of Urinary Tract Infections

Copyright © 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved. 2

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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CH 89 Treatment for UTI

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