Module 7: Drug Therapy of Urinary Tract Infections

Question 1

Urinary Tract Infections (UTIs)

Answer 1

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 (e.g.,
sepsis, pyelonephritis)

Complicated and uncomplicated UTIs
 Upper (kidney)
 Acute pyelonephritis
 Acute bacterial prostatitis

Lower (bladder and urethra)
 Acute cystitis
 Acute urethral syndrome

 Recurrent urinary tract infections

Question 2

Organisms That Cause UTIs

Answer 2

90% of uncomplicated, community-acquired
UTIs: Escherichia coli
 Hospital-acquired UTIs: Frequently caused by
Klebsiella, Proteus, Enterobacter,
Pseudomonas, staphylococci, enterococci, and
E. coli

Question 3

Drug Therapy of UTIs

Answer 3

Trimethoprim/sulfamethoxazole (TMP/SMZ) and
nitrofurantoin: Frequently the treatment of choice
for oral therapy of UTIs

Other drugs include
 Penicillins
 Aminoglycosides
 Cephalosporins
 Fluoroquinolones
 Carbapenems
 Methanamine

Question 4

Acute Cystitis

Answer 4

Symptoms
 Dysuria, urinary urgency, urinary frequency,
suprapubic discomfort, pyuria, bacteriuria (subclinical
pyelonephritis)

 Single-dose therapy
 Short-course therapy (3 days)
 Conventional therapy (7 days)

Question 5

Acute Uncomplicated
Pyelonephritis

Answer 5

Common in young children, older adults, women of
child-bearing 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

Question 6

Complicated UTI

Answer 6

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

Question 7

Recurrent UTI

Answer 7

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

Question 8

Acute Bacterial Prostatitis

Answer 8

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

Question 9

Urinary Tract Antiseptics

Answer 9

 Nitrofurantoin
 Methenamine

Question 10

Nitrofurantoin [Furadantin,
Macrodantin, Macrobid]

Answer 10

Low concentrations: Bacteriostatic
 High concentrations: Bactericidal
 Uses: Lower UTIs, prophylaxis, recurrent lower
UTIs Nitrofurantoin [Furadantin,
Macrodantin, Macrobid]

Question 11

Nitrofurantoin [Furadantin]

Answer 11

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