Pharmacology For UTI's And Renal System Infections

Question 1

Common UTI infection classifications

Answer 1

Urethritis
- infection/inflammation of the urethra

Cystits
- lower UTI (bladder and lower ureter)

Pyelonephritis
- upper UTI (kidney itself)

Prostatitis
- infection of the prostate

Symptomatic abacteria
- UTI symptoms without bacteria in urine or ability to culture bacteria

Asymptomatic bacteriuria
- presence of bacteria in urine without any symptoms

Question 2

What are the factors used to determine treatment of UTIs

Answer 2

Severity of symptoms

Causative agents/organisms

Antibiotic susceptibility

Location and classification of the infection

Question 3

Complicated vs uncomplicated UTIs

Answer 3

Uncomplicated

• acute UTI in an otherwise healthy person
• there is no functional or structural abnormalities of the urinary tract
• no comorbidities, no pregnancy, premenopausal, not preadolescent], non immunocompromised
• no history of childhood UTIs

Complicated

• acute UTI in the presence of either a structural abnormality and/or comorbidity
• very common in males, but females can also get it
• every UTI is considered this if it is not uncomplicated

Question 4

Recurrent vs reinfection vs relapse infection

Answer 4

Recurrent = two or more UTIs in a 6 month time frame (or 3+ within 1 year)

Reinfection = infection with a different organism

Relapse = infection with the same organism, refractory to treatment
- common in upper UTIs or resistant strains

Question 5

Effective UTI treatment requires what factors to be taken into account?

Answer 5

Must use agents that can accumulate in the urine
- just because it has serum concentration does not always mean it will accumulate in urine

Agent must be excreted in the kidney (not the liver or GI tract)

Less severe infections = oral
Severe infections = parenteral

Question 6

Most common causative organisms for UTIs

Answer 6

E-coli = by far #1 (75-90% cases)

Others:

• staphylococcus saprophyticus
• klebsiella
• proteus (usually uncomplicated)
• pseudomonas (usually complicated
• enterococcus species
• serratia marcans

Question 7

What is the most common medications for uncomplicated UTIs

Answer 7

TMP-SMX is #1
- cant give in sulfa allergies though

Urinary antiseptics are #2

• Fosfomycin
• nitrofurantoin
• methenamine
• quinolones

Question 8

What are common non-pharmacological treatments for prophylaxis against UTIs?

Answer 8

1) Lactobacillus probiotics
- competitively competes with E.coli and does minimal damage to normal gut flora

2) cranberry juice
- thought to reduce adherence of bacteria in urinary tract (not much evidence though)

3) increase fluid intake = reduces time for bacteria to build up residence in Urinary tract (you have to pee a lot)
- **caveat is that diuretic treatments actually increase UTI risk since it decreases urines acidity overall

Question 9

what is the one bacteria that is highly resistant to TMP-SMX?

Answer 9

P. Aeruginosa

Question 10

What UTI pathogen is cephalosporins not functional against?

Answer 10

Enterococci species

note P. Aeruginosa is only affected by ceftazidime and cefepime