Bladder infection

Lower Tract Infection

Infection of urethra

Lower Tract Infection

Infection of prostate

Lower Tract Infection

Infection of epididymis

Lower Tract Infection

Infection of Kidney

Upper Tract Infection

1. Ascending - urethra to bladder to kidneys
2. Hematogenous (descending) - uncommon
3. Lymphatic

• Organic acid concentration
• Urea concentration
• Low pH (5.5 or less)
• Prostatic secretions
• Micturition

• Glycoaminoglycan
• Taam-Horsfall
• Fimbrae
• Lactobacilli
• Immunoglobulin
• PMN

• 15-45 yo
• Normal, healthy females
• Lack structural/functional abnormalities

• Congenital abnormality
• Distortion of urinary tract, such as:

-Obstructions

-Neurologic deficit

-Can affect both genders

• Obstruction (benign prostatic hypertrophy, renal cyst)
• Metabolic (diabetes, renal failure)
• Functional (neurogenic bladder, vesicourethral reflux)
• Indwelling Catheters (urethral stent)
• Pregnancy
• Anatomy
• Contraceptives (diaphragms, condoms w/o lubrication or spermicidal condoms)
• Others (sexual intercourse, douching, lower estrogen levels)

Lower Tract

• Dysuria
• Urgency
• Frequency
• Suprapubic Heaviness
• Nocturia
• Hematuria
• Discolored or cloudy

Upper Tract

• Flank pain
• Back pain
• Abdominal pain
• Fever
• N/V

• Altered mental status
• Change in eating habits
• GI symptoms

• Proteus mirabilis
• Escherichia coli
• Staphylococcus saprophyticus
• Klebsiella pneumoniae

• FIRST LINE: Trimethoprim/Sulfamethoxazole (Bactrim) Double Strength 1 PO BID x 3 days

If there is an allergy to TMP/SMX, patient was hospitalized in past 6 months, or P. aeruginosa is suspected:

• Levofloxacin 250 mg PO daily x 3 days
• Ciprofloxacin 250 mg PO q 12 hrs x 3 days

Follow Up for Acute Uncomplicated Cystitis

• Not routinely needed
• If symptoms do not respond to treatment or reoccur, obtain urine culture and retreat

Chlamydia trachomatis

Escherichia coli

Gardeneralla vaginalis

Ureaplasma urealyticum

Neisseria gonorrhoeae

Staphylococcus spp.

• Trimethoprim/Sulfamethoxazole (Bactrim DS) 2 tabs PO single dose

OR

• Trimethoprim/Sulfamethoxazole (Bactrim DS) 1 tab PO BID x 3 days

If STD suspected:

Azithromycin 1 g PO single dose + TMP/SMX DS

 OR

Doxycycline 100 mg PO BID x 7 days + TMP/SMX DS

• NO symptoms
• Two consecutive urine cultures > 10⁵ of the same organism
• Patient Populations:

Elderly

Females

Pregnant

Klebsiella pneumoniae

Escherichia coli

Enterococcus faecalis

Proteus mirabilis

Staphylcoccus saprophyticus

Pediatrics

Prego

Do not treat adult female if not pregnant

• High grade fever
• Severe flank pain
• N/V
• Dehydration

Klebsiella pneumoniae

Proteus mirabilis

Enterococcus faecalis

Pseudomonas aeruginosa

Escherichia coli

Trimethoprim/Sulfamethoxazole DS 1 PO BID x 14 days

OR

Levofloxacin 500 mg PO daily x 14 days

OR

Ampicillin 2 g IV q 6 hrs + Gentamicin 1mg/kg/dose IV x 14 days

Once they are stable and afebrile, can switch to PO

• Effective therapy should stabilize patient within 12-24 hrs
• Reduction in urine bacteria within 48 hrs
• Once pt afebrile, D/C IV therapy
• F/U urine culture 2 weeks after completion of therapy

• Hospitalized within 6 months
• Urinary Catheter
• Nursing Home Resident

• Pseudomonas aeruginosa
• Enterococci

Complicated

Catheterization, obstruction of urinary tract, renal and urinary stones, bladder outlet obstruction

Uncomplicated

Rare

Prolonged Treatment

10-14 days

Follow up with culture and sensitivity at 4-6 weeks after completion of treatment

• Hormonal changes cause urinary stasis and reduce defenses
• Increased content of amino acids, vitamins, and nutrients encourage bacterial growth

DOC --> Nitrofurantoin 100 mg BID x 7 days

Alt:

Amoxicillin/Clavulanate q 12 hrs x 7 days

OR

Cephalexin 500 mg q 12 hrs x 7 days

Females

20% with cystitis

Sexual intercourse

Contraceptives

Treat conventionally then prophylaxis for 6 months

Trimethoprim/Sulfamethoxazole 1/2 single strength tab PO daily

OR

Trimethoprim 100 mg PO daily

OR

Nitrofurantoin 50 mg PO daily

Post-Coital

Void after intercourse

Single dose TMP/SMX following intercourse (not common)

Postmenopausal

Topical estrogen cream - use vaginally

• Avoid products that irritate urethra (bubble bath, scented feminine products)
• Take showers instead of baths
• Cleanse the genital area before sexual intercourse
• Urinate after sexual intercourse
• Change soiled diapers in infants and toddlers promptly
• Drink plenty of water to remove bacteria from the urinary tract
• Do not routinely resist the urge to urinate
• For you dirty girls, wipe properly damnit!
• Wear cotton undies
• Stop smoking (nicotine irritates bladder)

• Acidic Foods
• Citrus Fruits
• Spices
• Tomatoes
• Alcohol
• Caffeine
• Chocolate

Non-Pharmacological Therapy for UTIs

• Hydration
• Lactobacillus probiotics
• Cranberry juice
• Estrogen replacement

Urinary Analgesics, Antispasmodics, Antispectics

• Phenazopyridine (Pyridium)
• Urimax
• Urised

Helps with painful urination and urgency

Should not be used for > 2 days b/c they mask the true UTI symptoms

• Avoid taking with antacids, calcium, iron, zinc, or multivitamins
• Take them either at least 2 hrs before or 2 hrs after the antibiotic

• Similar to that of UTI
• Reflux of infected urine into prostate gland
• Sexual intercourse
• Catheterization

G- Enterics

Escherichia coli (most common in chronic prostatitis) Klebsiella pneumoniae

Proteus mirabilis

• High fever
• Chills
• Myalgia
• Localized pain (perineal, rectal, sacrococcygeal)
• Urinary symptoms (frequency, urgency, dysuria)
• Lower back pain and suprapubic discomfort in chronic prostatitis

Acute: swollen, tender, or indurated gland

Chronic: indurated, enlarged gland

• Bacteriuria
• Bacteria in prostatic secretions

FIRST LINE:

Trimethoprim/Sulfamethoxazole DS 1 tab PO BID x 4 weeks

OR

Ciprofloxacin 500 mg PO BID x 4 weeks

OR

Levofloxacin 750 mg PO QD x 4 weeks

Treat Chronic Prostatitis for 6-12 weeks

Suppressive Therapy:

Ciprofloxacin 500 PO 3x q week

OR

TMP/SMX SS 1 tab PO QD

OR

Nitrofurantoin 100 mg PO QD