Obat-obat pada ISK(infeksi

saluran kencing)
 Obat pada ISK
 Early detection/Rx →penting untuk mencegah infeksi sistemik
&bacteremia
 Antibiotik hanya direkomendkan jika diagnosis telah ditegakkan
 Selection of antibiotic must be individualized and consider:
 Side effect profile
 Cost
 Bacterial resistance
 Effect of impaired renal function on dosing
 Possible adverse drug reactions ↑ in elderly (multiple drugs, co-morbidities.
Osborne, 2004
Swart et al. 2004
 Treatment Plan
 Recommended Treatment Regimens for Acute, Uncomplicated UTI’s in the Elderly
Bacterial
Common Compliance/ Cost Wom
Treatment Dosage/Duration Coverage/ Men
Side Effects Convenience I/E en
Resistance

Sulfonamide Fair/Good
160/800 mg po bid x 3-14* days (E. coli 20%)
Trimethoprim- √
*available in a syrup ↑ resistance nausea, rash I √
Sulfamethoxazole longer duration of
If CrCl <15-30 mL/min, ↓in half Less effective
TMP-SMX bid ↓ compliance

Fluoroquinolones
100- 250 mg po bid x 3-14* days Good/Good
Ciprofloxacin (2nd
If CrCL <30mL/min ↓ by half bid, longer
gen) headache,
gram (-) effective duration ↓ √ √
dizziness, E
250 mg po daily x 10 days gram (+) only fair compliance
Levofloxacin (3 rd
nausea, diarrhea
(complicated upper and lower Excellent
gen)
UTI)

VE, often
3 g powder, dissolved in water gram (-) effective diarrhea, vaginitis, √ √
Fosfomycin Excellent not on
*single dose gram (+) less effective nausea, rhinitis
formularies

nausea, vaginitis,
100 mg po bid x 7 days Narrow spectrum diarrhea Fair Prostat
Nitrofurantoin √
If CrCL <40 mL/min gram (-) effective ↑ rate of severe 7-day regimen & I itis
(Macrobid)
not recommended gram (+) effective pulmonary & bid, ↓ compliance NR
hepatotoxicity

↑ resistance 2° Beta
Miscellaneous
Lactamase enzymes in
Beta Lactam AB’s:
resistant bacteria PCN-anaphylaxis Prostat
Cephalosporins (Cefuroxime, cefpodoxime) √
2nd/3rd gen Abdominal Fair for bid dosing I itis
Penicillins (ampicillin), Carbapenems (imipenem)
Cephalosporins cramping diarrhea NR
Phenazopyridine (Pyridium)—not appropriate
>resistant to beta
for elderly or patients with renal insufficiency
lactamase

Data adapted from Swart et al. (2004), Osborne (2004), Wagenlehner et al. (2005), Mahan-Buttaro et al.
(2006) and Evercare Corp (2004)
I = inexpensive; E = expensive; VE = very expensive; NR = not recommended
*Longer duration for complicated UTI per individual’s clinical status
 Treatment Plan
 Duration of Antibiotic Therapy: Ongoing Debate
 Research

Double-blind randomized controlled trial compared 3-and

7-day courses of oral ciprofloxacin, 250mg bid.
183 elderly women > 65 yrs old. Acute, uncomplicated
UTI.
Vogel et al., 2004 *Outcome—bacterial eradiation @ 2 days, Rx was 98% in
3-day group; 93% in 7 day group.
3-day course not inferior to 7 day
Better tolerated
Rates of relapse & re-infection 6 weeks later, both groups
similar

Proposed long term prophylaxis of recurrent UTI—

Brumfitt et al./ demonstrated benefits from low dose, long term Rx with
Stromm et al., nitrofurantoin macrocrystals 100 mg po at bedtime. There
1980 was minimal/no association w/development of resistance
in susceptible strains.
Treatment Plan
AB Rx for at least 10 days for institutionalized

elderly, as short-term therapy may not be as

effective.

Ten-14 days, if indicated, for complicated UTI.

(recommended for males)

Evercare, 2004

Conventional regimen of 7-10 days duration is

usually recommended.
Wagenlehner et al. 2005
Treatment Plan
 Complicated UTI
 Associated with azotemia, obstruction, or indwelling foley
 Can lead to bacteremia, life-threatening systemic infection

Recommended Treatment for Acute Complicated UTI

IV antibiotic therapy--*consider renal & hepatic elimination,
creatinine clearance for dosage adjustment
 3rd generation cephalosporin (Ceftriaxone = Rocephin) Rx 1 gram IV
every 24 hours
 Or if fluoroquinolones (Levofloxacin = Levaquin) 250-500 mg IV every 24
hours
 Continue until afebrile, minimum of 48 hrs, then start oral therapy and
fluids x 14 days.
Mahan-Buttaro et al., 2006