URINARY TRACT INFECTIONS

Dr. Zienab Halem

Faculty of pharmacy SCU
• Lower UTIs known as bladder infection ( cystitis )
• Upper UTIs known as kidney infection ( pyelonephritis )

• Factors :
Renal failure , male sex , pregnancy , diabetes mellitus , prostate
hypertrophy , recent antimicrobial use .
• The most common cause of infection is E.Coli .

• Symptoms of cystitis :
Dysuria ,frequent urination , haematuria , urgency , foul-smelling urine
.

• Symptoms of pyelonephritis :
Frequency , dysuria , haematuria , fever , suprapubic pain , flank
pain , elevated WBCs , nausea , vomiting .
 DIAGNOSIS
• Urine analysis

Urine containing WBCs or pus . ( WBCs ≥ 5 – 10 cells / mm3 )

Cloudiness
Nitrite ( positive )
Leukocyte esterase ( positive )
• Treatment :
• Uncomplicated cystitis .
Trimethoprim / sulphamethoxazole ( twice daily for 3 days )
Or nitrofurantoin 100 mg twice daily for 5 days
Or Fosfomycin 3 g one dose

Alternatives :
Fluoroquinolones for 3 days
B- lactams for 3 – 7 days
• Uncomplicated pyelonephritis :
- Out patient therapy :
Trimethoprim / sulphamethoxazole for 14 days
Fluoroquinolones for 5 – 7 days

- Uropathogen resistance
Ceftriaxone
Or aminoglycosides ( Amikacin and gentamicin )
• UTIs in pregnancy

7 days treatment regimen .

Amoxicillin

Antibiotics to avoid
Fluoroquinolones , tetracyclines , aminoglycosides
Trimethorprim / sulfamethoxazole ( especially during the late third
trimester )
• If patient has 3 or more UTIs in 1 year and is
temporally related to sexual activity :

Use post intercourse prophylaxis with trimethoprim /

sulphamethoxazole one tab
Or nitrofurantoin 50 – 100 mg one tab