C/19. Nitrofurantoin. Phosphomycine. Pharmacotherapy of urinary tract infections.

Question 1

Drugs need to know in this topic

Answer 1

Nitrofurantoin, Fosfomycin

Question 2

Nitrofurantoin

Answer 2

Classified as urinary antiseptic
lacks systemic antibacterial effects

Active against many urinary tract pathogens (not Proteus and Pseudomonas)
Used in the treatment of uncomplicated lower UTI’s

Oral
Urine acidification enhances the drug activity
Rapid renal elimination

when uses prolong
GI distress
Skin rash
Pulmonary infiltrate
Phototoxicity
Acute hemolysis in G6PD deficient patients

Question 3

Fosfomycin

Answer 3

Inhibits the bacterial enzyme enolpyruvate transferase->blocking synthesis of N-acetylglucosamine (precursor of bacterial cell wall synthesis)
Bactericidal effect

Gram-positive and -negative
Used in the treatment of
uncomplicated lower UTI’s in
women (oral, single dose)

Oral, parenteral
Renal elimination; excreted unchanged

GI distress (diarrhea)

Question 4

Pharmacotherapy of urinary tract infections.

Answer 4

Uncomplicated UTI
Acute cystitis in women; Nitrofurantoin PO and
TMP-SMX PO
Acute prostatitis in men; TMP-SMX PO or
Ciprofloxacin PO

Pyelonephritis; Ciprofloxacin PO/IV
TMP-SMX PO/IV

Pelvic inflammatory disease (PID); Clindamycin IV and Gentamycin PO