—— is a lower UTI that occurs most often in women of child-bearing age.
Acute Cystisis
Clinical manifestations of Acute Cystisis
- Dysuria
- Urinary urgency
- Urinary frequency
- Suprapubic discomfort
- Pyuria
- Bacteriuria
30% of women w/ Acute Cystisis also have asymptomatic —— UTI
Upper (ie: subclinical pyelonephritis)
What is treatment regimen for Acute Cystisis?
nitrofurantoin for 5 days
What are the principle causative organsims of Acut Cystisis?
E. Coli
Staph
saprophyticus
Enterococcus faecalis
—- is a UTI infection of the kidneys and is common in young children, older adults, and women of child-bearing age.
Acute Uncomplicated Pyelonephritis
—- is the causative agent of Acute Uncomplicated Pyelonephritis.
E. coli
Clinical manifestations of Acute Uncomplicated Pyelonephritis
- Fever
- Chills
- Severe flank pain
- dysuria
- polyuria
- urinary urgency
- pyuria
- bacteriuria
Treatment for Acute Uncomplicated PYelonephritis
Oral antibiotics for 14 days
—– is a UTI characterized by a structural/functional abnormality of the urinary tract that predisposes them to developing an infection.
Complicated UTI
Examples of predisposing factors that cause a complicated UTI
- Prostatic Hypertrophy
- Renal Calculi (stones)
- Nephrocalcinosis
- Renal/Bladder Tumors
- Uretic Stricture
- Indwelling urinary catheter
Essentially anything that can block/restrict flow
Complicated UTI treatment
to be successful, organisms must be identified
(that’s why it’s complicated)
remember: CULTURE BEFORE EMPIRIC THERAPY
—– is a UTI that results from a relapse or from a reinfection.
Recurrent UTI
Difference b/t Relapse and Reinfection
RELAPSE is caused by recolonization w/ same organism
REINFECTION is caused by recolonization w/ new organism
More than 80% of Recurrent UTIs in females are due to —–
reinfection (recolonization w/ new organism)
- usually involve lower urinary tract
Infrequent reinfections (1-2 a year) can be treated as —-
separate infections
When reinfections are frequent (3+ a year) —— treatment is necessary.
prophylactic
20% of Recurrent UTIs are due to —-
relapse (recolonization w/ same organism)
—– is a UTI characterized by inflammation of the prostate from a local bacterial infection.
Acute Bacterial Prostatitis
Clinical manifestations of Acute Bacterial Prostatitis
- Fever
- Chills
- Malaise
- Myalgia
- Localized pain
- various UTI symptoms
Types of UTIs
1) Acute Cystitis
2) Acute Uncomplicated Pyelonephritis
3) Complicated UTIs
4) Recurrent UTIs
5) Acute Bacterial Prostatitis
What was our prototype drug for UTIs?
nitrofurantoin
MOA: Nitrofurantoin
harmless outside of the bacteria but once it’s absorbed, it is converted into a reactive intermediary that destroys the bacteria from the inside
Like a Trojan Horse
Which type of UTIs are nitrofurantoin useful for?
Uncomplicated UTIs
Also for Acute Cystitis and prophylactic use
Who is Nitrofurantoin contraindicated for?
Renal Impairment
- it is really excreted and can build up to dangerous levels (toxicity)
- doesn’t make it past kidneys into urinary tract
Which side effects would warrant discontinuing Nitrofurantoin?
Jaundice Anorexia Upper abdominal pain N/V Dark colored urine Increased need to sleep Clay covered stool Encephalitis & Eccimosis (bruising)
Teaching for Nitrofurantoin?
- Take w/ food (increases absorption by 40%)
- may discolor the urine (brown) (harmless)
Since it discolor urine, we need to look for other JAUNDICE signs instead of Dark colored urine
Adverse effects of Nitrofurantoin
- Liver Failure (JAUNDICE)
- Optic Neurotics (vision issues)
- Peripheral Neuropathy (tingling an early sign)
- Lung fibrosis (difficulty breathing)
- Hemolytic Anemia (SOB due to no O2)
