ANTIMICROBIAL AGENTS

IN UPPER UTI
EMMANUAL
PIOUS
59
 URINARY TRACT
INFECTIONS
• UTI is defined as the disease caused by
microbial invasion of the urinary tract
that extends from renal cortex to urethral
meatus
BASED ON ANATOMICAL SITE

UPPER UTI
• KIDNEY(PYELONEPHRITIS)
• URETER(URETERITIS)
LOWER UTI
• BLADDER(CYSTITIS)
• URETHRA(URETHRITIS)
ETIOLOGY
• Most common- BACTERIAL UTI
-E.coli(70%)
-Klebsiella pneumoniae
-Proteus
-Pseudomonas
PYELONEPHRITIS
• Suppurative inflammation of kidney
parenchyma, calyces and renal pelvis
caused by pyogenic bacteria
• PYELONEPHRITIS
-acute
-chronic
 TREATMENT
OF
PYELONEPHRITIS
• Bacteriological investigations are very
important to direct the choice of drug- till
then EMPIRICAL THERAPY
• Doses are similar to those for any
systemic infection
• In uncomplicated AP, empirical oral
therapy is started to prevent complications
• In complicated AP(kidney damage and
septicemia), potent parenteral
antibacterials are immmediately
administered
• Even after the patient has clinically
improved, oral therapy is recommended
to continue if the patient is susceptible
for relapse\reinfection
• Duration of treatment-10-14 weeks,but
longer treatment may be required
EMPIRICAL ANTIMICROBIAL
REGIMENS FOR ACUTE UTI
1. CIPROFLOXACIN 250-500 mg 12 HOURLY
2. OFLOXACIN 200-400 mg 12 HOURLY
3. COTRIMOXAZOLE 960 mg 12 HOURLY
4. CEPHALEXIN 250-500 mg 6 HOURLY
5. CEFPODOXIME PROXETIL 200 mg 12 HOURLY
6. AMOXICILLIN+CLAVULANATE(500+125 mg) 8
HOURLY
• For acute pyelonephritis the drugs may be given for 2 weeks
• For chronic pyelonephritis, the regimen is for 3-4 months
• In COMPLICATED ACUTE
PYELONEPHRITIS
immediate intravenous administration of
COAMOXICLAV + GENTAMICIN
OR
PIPERACILLIN + TAZOBACTAM
• FQs and cotrimoxazole contraindicated
in pregnancy
• Piperacillin/Ticarcillin – used only in
serious Pseudomonas infection
• Chloramphenicol though effective in
many cases, should be restricted to
pyelonephritis – causative bac. sensitive
only to this antibiotic
• Nitrofurantoin is not suitable for
pyelonephritis
FAVOURABLE PH FOR
ANTIMICROBIAL ACTION
ACIDIC ALKALINE PH IMMATERIAL
NITROFURANTOIN COTRIMOXAZOLE CHLORAMPHENICOL
METHENAMINE AMINOGLYCOSIDES AMPICILLIN
TETRACYCLINES GENTAMICIN
CLOXACILLIN CEPHALOSPORINS
FLUOROQUINOLONES
THANK YOU !!