Urinary tract antiseptic

Urinary tract infections in women of child bearing age and in the elderly are one of the most common problems Common pathogens Escherichia coli Staphylococcus saprophyticus Klebsiella pneumoniae Proteus mirabilis

UTA
These infections may be treated with any one of a group of agents called UTA. These drugs do not achieve antibacterial levels in the circulation, but because they are conc.in the urine, microorganisms at that site can be effectively eradicted.

Methenamine-MOA
It must decompose at an acidic pH of 5.5 or less in the urine Thus producing formaldehyde, which is toxic to most bacteria The reaction is slow, requiring 3 hours to reach 90% decomposition Bacteria do not develop resistance to formaldehyde Methenamine is frequently formulated with weak acid such as mandelic acid or hippuric acid, which lowers the pH of urine, thus aiding decomposition of the drug

MOA

ADME
Administered orally It is distributed throughout the body fluids But no decomposition of the drug occurs at pH 7.4, thus systemic toxicity does not occurs. The drug is eliminated in the urine

ADR
Gastrointestinal distress In higher doses Albuminuria Hematuria Rashes

Contraindicated[CI]
In patients with renal insufficiency[mandelic acid accumulates in blood-acidosis] In patients with hepatic insufficiency[the released ammonia is not detoxifiedCNS toxicity] Sulfonamide[antagonism]

Nitrofurantoin
It is nitrofuran derivative It is less commonly employed for treating UTIs because of its narrow antimicrobial spectrum and its toxicity

MOA
It blocks bacterial carbohydrate metabolism by inhibiting its acetyl CoA synthesis. Sensitive bacteria reduce the drug to an active agent,nitroanion superoxide and other toxic reactive intermediates which damage bacterial DNA It is primarily bacteriosatic but acts as bactericidal in higher conc. and in acidic urine It loses its antimicrobial action at pH 8. Acidifying agents such as vit C and cranberry juice increases its effectiveness.

Antibacterial spectrum
Primarily active against gram negative bacteria[E.coli and proteus mirabilis]. Some extant gram positive organisms such as staphylo.aureus and enterococcus faecalis

ADR
Gastrointestinal disturbancesnausea, vomiting, epigastric pain, diarrhoea An acute reaction with chills, fever and leucopenia[occasionally] Peripheral neuritis [long term use] Haemolytic anaemia[G-6-PD]] Liver damage[hepatitis], pulmonary reaction with fibrosis[chronic use] Urine becomes dark brown on exposure to air

Other drugs used to treat UTI

Cotrimoxazole Beta lactam antibiotics Aminoglycosides Tetracyclines Chloramphenicol

Drugs used in UTIs

Better in acidic urinary pH

Better in alkaline urinary pH

Nitrofurantoin Tetracyclines Methicillin Cloxacillin

Cotrimoxazole Gentamicin Cephalosporins FQs

Urinary pH is immaterialnalidixic acid, chloramphenicol, ampicillin

Urinary analgesics-phenazopyridine
It is an orange dye which exerts analgesic effects in UTIs and provides symptomatic relief from burning sensation, dysuria and urgency due to cystitis. It is devoid of antibacterial activity ADR:-Nausea, epigastric distress, urine colour turns orange red due to its metabolite. USES:-urinary tract analgesic[200mg TDS]