Clin Pharm - Urinary Tract Infection & Prostatitis

Anatomy of the Lower Tract Infections

• Cystitis: Bladder infection.

• Urethritis: Urethral involvement.

• Prostatitis: Inflammation of the prostate.

• Epididymitis: Infection of the epididymis

CUPE

Anatomy of the Upper Tract Infections

• Pyelonephritis: Involvement of the kidneys.

• Associated with systemic symptoms like fever and flank pain.

• Defined as presence of microorganisms in urine (no contamination).

• Microorganisms have potential to invade tissues and adjacent structure

PADM

Classifying the Condition: No structural or functional abnormalities interfering with urine flow or voiding.

Uncomplicated

Classifying the Condition: Predisposing lesions (stones, catheters, prostatic hypertrophy) that interfere with defenses.

Complicated

Classifying the Condition:

• Reinfection: New organism (majority).

• Relapse: Same initial organism.

Recurrent

Bacteria typically originate from the bowel flora. Entry occurs via three main pathways:

Ascending Pathway, Hematogenous, Lymphatic

Host defenses like ___ are critical in preventing invasion.

urine flow and acidity

Primary Pathogens: The Usual Suspects (in order)

1. Escherichia coli (Uncomplicated) :80-90%

2. Escherichia coli (Nosocomial) :<50%

3. Enterococci (Hospitalized) :2nd Most Freq

4. S. saprophyticus / Klebsiella :Others

Multiple organisms may be isolated in patients with stones, chronic abscesses, or indwelling catheters

Clinical Presentation & Symptoms in Lower UTI

Dysuria, Urgency, Frequency, Nocturia, Suprapubic Heaviness, Gross Hematuria.

Clinical Presentation & Symptoms in Upper UTI

Flank Pain, High Fever (>38.3°C), Nausea, Vomiting, and Malaise.

Clinical Presentation & Symptoms in Elderly Patients

Often lack specific urinary symptoms. Present with altered mental status or change in eating habits.

Diagnostic Benchmarks of Standard threshold for "Significant Bacteriuria"

105 CFU / mL

Diagnostic Benchmarks:

• 50% of symptomatic women present with lower counts ( CFU/mL).

• Pyuria: >10 WBC/mm³ correlates with infection.

• Quantitative urine culture is the most reliable method.

What Laboratory Evaluation Methods?
Function / Target: Microscopic identification

Clinical Significance: Detects bacteria in unspun or centrifuged urine specimens.

Gram Stain

What Laboratory Evaluation Methods?

Function / Target: Nitrate-reducing bacteria

Clinical Significance: Specific for enteric bacteria like E. coli.

Nitrite Test

What Laboratory Evaluation Methods?

Function / Target: Detects Pyuria

Clinical Significance: Rapid dipstick test for white blood cells in urine.

Leukocyte Esterase

What Laboratory Evaluation Methods?

Function / Target: Quantification

Clinical Significance: Key to distinguishing contamination from actual infection

Urine Culture

First-Line Oral Antimicrobials

TMP-SMX, Nitrofurantoin, Fosfomycin, Quinolones

(TNiFoQui)

What First-Line Oral Antimicrobials?

Adverse Reactions: Rash, Stevens-Johnson

Clinical Comments: Highly effective against enteric bacteria; prophylactic use possible.

TMP-SMX (Trimethoprim/sulfamethoxazole)

What First-Line Oral Antimicrobials?

Adverse Reactions: GI intolerance, neuropathies

Clinical Comments: Advantage: Lack of resistance even after long courses.

Nitrofurantoin

What First-Line Oral Antimicrobials?

Adverse Reactions: Diarrhea, headache

Clinical Comments: Single-dose therapy for uncomplicated infections.

Fosfomycin

What First-Line Oral Antimicrobials?

Adverse Reactions: Tendonitis, dizziness

Clinical Comments: Broad spectrum; reserve for pyelonephritis to avoid collateral damage.

Quinolones

Managing Pyelonephritis

Milder Cases:

Oral fluoroquinolones (7-10 days) or TMP-SMX (14 days).

Managing Pyelonephritis

Severe Cases:

Hospitalization with IV fluoroquinolones or aminoglycosides.

Managing Pyelonephritis

Risk Factors:

Recent hospitalization or catheters suggest P. aeruginosa.

Managing Pyelonephritis

Follow-up:

Obtain urine culture 2 weeks post-therapy to check for relapse.

What Special Populations:

• Considered "Complicated" by definition.

• Requires prolonged treatment (10-14 days initially).

• Chronic Prostatitis: May require 4-6 weeks of therapy.

• Culture always required before treatment

UTIs in Men

What Special Populations:

• Asymptomatic: Withhold antibiotics; remove catheter ASAP.

• Symptomatic: Remove catheter and treat as complicated infection.

• Antibiotics only postpone bacteriuria in long-term use.

Catheterized Patients

Safety in Pregnancy

Preferred Agents:

Cephalexin, Amoxicillin, or Amoxicillin-Clavulanate for 7 days.

Safety in Pregnancy

Contraindicated

Tetracyclines, Quinolones, Sulfonamides

What contraindicated drug for pregnant women causes: Teratogenic effects

Tetracycline

What contraindicated drug for pregnant women causes: Bone development risk.

Quinolones

What contraindicated drug for pregnant women causes: Third trimester (Kernicterus).

Sulfonamides

Managing Recurrence:

Treat each episode separately using short-course therapy (3-day regimens).

Infrequent (<3/year)

Managing Recurrence: Long-term prophylaxis (e.g., Nitrofurantoin 50mg daily) for 6 months.

Frequent Symptomatic

Managing Recurrence: Self-administered single-dose TMP-SMX taken post-intercourse helps prevent reinfection.

Activity-Related

Relapse after 2 weeks may require___ weeks of treatment and ___ work-up.

4-6; urologic