Management of uncomplicated urinary tract infections

Abstract

Uncomplicated urinary tract infections are among the most frequently occurring infections in the United States, resulting in an estimated 8 million office visits and 1 million hospital admissions each year.1-3 Between 40% and 50% of women have reported having at least one urinary tract infection in their lives. 4Urinary tract infections can be classified by anatomic site of involvement into lower and upper urinary tract infections. Infections of the lower urinary tract include cystitis, urethritis, prostatitis, and epididymitis, and those of the upper urinary tract include pyelonephritis. Urinary tract infections may be further classified as complicated or uncomplicated. In women with a structurally and functionally normal urinary tract, cystitis and pyelonephritis are considered uncomplicated urinary tract infections. Urinary tract infections in men, elderly people, pregnant women, or patients who have an indwelling catheter or an anatomic or functional abnormality are considered complicated urinary tract infections. In this article, we outline the pharmacologic approach to the prevention and treatment of uncomplicated cystitis. ETIOLOGYRisk factors for urinary tract infections in women include frequent sexual intercourse, lack of urination after intercourse, use of a diaphragm, use of a spermicide, and a history of recurrent urinary tract infections.5,6 Although the long-term adverse effects associated with uncomplicated urinary tract infections appear to be minimal, if left untreated, urinary tract infections can interfere with daily living. As many as 80% of uncomplicated urinary tract infections are caused by Escherichia coli, followed by Staphylococcus saprophyticus in as many as 5% to 15% of cases. Enterococci, Klebsiella species and Proteus mirabilis account for a small percentage of overall infections. 7 OVERVIEW OF ANTIBIOTICSThe antimicrobial agents most commonly used to treat uncomplicated urinary tract infections include the combination drug trimethoprim and sulfamethoxazole, trimethoprim, ␤-lactams, fluoroquinolones, nitrofurantoin, and fosfomycin tromethamine. These agents are used primarily because of their tolerability, spectrum of activity against suspected uropathogens, and favorable pharmacokinetic profiles.8 In the treatment of urinary tract infections, the resolution of bacteriuria has been correlated with the concentration of the antimicrobial agent in the urine rather than serum levels.9 All the antimicrobial agents approved for the treatment of urinary tract infections achieve inhibitory urinary concentrations that significantly exceed serum levels. Also, agents such as trimethoprimsulfamethoxazole or the fluoroquinolones that eradicate aerobic gram-negative flora but have little effect on the vaginal and fecal anaerobic flora seem to provide the best long-term cures for uncomplicated urinary tract infections. 8 Resistance to antibioticsBecause most uncomplicated urinary tract infections are treated empirically, it is important for clinicians to recognize resistance patterns of uropathog...

Suscetibilidade antimicrobiana de uropatógenos em pacientes ambulatoriais na cidade de Goiânia, GO

“…Mesmo apresentando uma alta concentração urinária, estes antimicrobianos não são recomendados para tratamento das ITUs por causa da resistência e alta recorrência, se comparados a outros agentes, sendo esta resistência justificada principalmente pela produção de β-lactamases e por alterações nas proteínas de ligação das penicilinas (PBPs) das bactérias. Na atualidade, para uma boa resposta terapêutica no caso das ITUs, deve-se utilizar a amoxicilina associada ao ácido clavulânico 14 . A elevada resistência microbiana ao trimetoprim/ sulfametoxazol é justificada pelo fato de ser um antimicrobiano mais antigo, já muito utilizado em infecções, possivelmente de uma maneira indiscriminada e aleatória com a automedicação 23 .…”

Investigation of Fosfomycin Trometamol Susceptibility in Escherichia coli Strains Isolated from Urinary Tract Infections

“…Fosfomisin, peptidoglikan sentezinin ilk basamağında üridin difosfat-Nasetilmuramik asit formasyonunu katalize eden bakteriyel sitoplazmik bir enzim olan, purivil transferazı inhibe eden bakterisidal bir ajandır (2) . Fosfomisin ve diğer antibakteriyel ajanlar arasında çok az çapraz direnç vardır çünkü kimyasal yapısı ve etki yeri diğer ajanlardan farklıdır.…”

“…E. coli ve Citrobacter suşlarına karşı %90'dan daha çok, Enterobacter spp, Klebsiella pneumoniae, Klebsiella oxytoca, Proteus mirabilis, Staphylococcus aureus, koagülaz negatif Stafilokoklar ve Enterococcus suşlarının %70'den fazlasına karşı etkilidir. Pseudomonas aeruginosa ve Acinetobacter suşları ise fosfomisine daha dirençlidir (2) . Kimyasal yapısı ve etki şekilleri muhtemel farklı olduğu için fosfomisin ve diğer antimikrobiyal ajanlar arasındaki çap-raz direncin az olduğu görülür (2) .…”

“…Pseudomonas aeruginosa ve Acinetobacter suşları ise fosfomisine daha dirençlidir (2) . Kimyasal yapısı ve etki şekilleri muhtemel farklı olduğu için fosfomisin ve diğer antimikrobiyal ajanlar arasındaki çap-raz direncin az olduğu görülür (2) . Çalışmamızda mikrobiyoloji laboratuvarına gelen idrarlarda izole edilen E. coli suşlarında GSBL pozitifliği ve FT direnç oranlarının araştırılması amaçlan-mıştır.…”

Fluoroquinolone-Resistant Uncomplicated Urinary Tract Infections, Chinese Herbal Medicine May Provide Help

“…Uncomplicated urinary tract infections (UTIs) were among the most common bacterial infections seen in general practice in women (Jancel et al,2002;Huang et al,2002). Of women between ages 20 and 40 years, 25% to 35% had a UTI (Foxman et al,2000).…”