URINARY ANTISEPTICS

The urinary antiseptics inhibit the growth

of many species of bacteria.

Introduction
They cannot be used to treat systematic
infections because effective
concentrations are not achieved in plasma
with safe doses. However, because they
are concentrated in the renal tubules,
they can be administered orally to treat
infection of the urinary tract.
Furthermore, effective antibacterial
concentrations reach the renal , pelvis and
the bladder. Treatment with such drugs
can be thought of as local therapy. Only in
the kidney and bladder with rare
exceptions are adequate therapeutic
levels achieved.
Methenamine: This is a pro-drug and
urinary antiseptic that owes its activity to
its capacity to generate formaldehyde.
The compound decomposes in water to
form formaldehyde. NH4(CH2)6 + 6H2O +
4H+→4NH+4 + 6HCHO
 

Mechanisms of action
Mandelicand hippuric acids with which
methenamine are combined provide
supplementary antibacterial action.
Nitrofurantoin: This is a bacteriostatic
antibiotic used to treat bladder infection.
It is not effective on the kidneys. In high
concentrations, it may be bactericidal.

Mechanisms of action cont’d

Presumably, it disrupts bacterial enzyme
systems. It is not used to treat infections
other than simple cystitis. It is mutually
antagonistic with quinolone antibiotics in
vitro and as such, should not be
combined. It is not used in patients with
creatinine clearance of 60ml/min or less.
Fosfomycine tromethamine: This is an
antibiotic that is bactericidal in the urine
at therapeutic doses.
The bactericidal action is because of its
inactivation of the enzyme enolpyruvyl
transferase, thereby blocking the
condensation of uridine diphosphate-N-
acetyl glucosamine with P-enolpyruvate,
one of the first steps in bacterial cell wall
synthesis.
Methenamineis active against gram
positive and negative bacteria.

Spectrum of activity
Nitrofurantoin is active against both as
well, though it mostly only inhibits
growth.

Spectrum of activity cont’d

Nalidixic acid is effective against gram
negative bacteria with minor gram
positive activity. It is bactericidal at high
concentrations and bacteriostatic at lower
concentrations.

Spectrum of activity cont’d

Azithromycin and trimetoprim are not
urinary antiseptics, but they are very
potent antibiotics for treating urinary tract
infections and deserve to be mentioned
here.

Spectrum of activity cont’d

Urinary acidifiers are not curative. They
are taken in combination with a proper
diet to help maintain a healthy urinary
tract.

Spectrum of activity cont’d

Methigel is a supplemental source of
dimethionine and aids in maintaining a
low urine pH.

Spectrum of activity cont’d

THE END