CH 89 Treatment For UTI

Chapter 89
Drug Therapy of Urinary

Tract Infections
Copyright 2016, 2013, 2010 by Saunders, an imprint of Elsevier Inc. All rights reserved.
Urinary Tract Infections (UTIs)

Second most common infection
Sexually active young women
Older adult women in nursing homes
25% to 35% develop at least one UTI a year

30% to 50% have bacteria at any given time
Less frequent in males
Occurrence likely associated with

complications (for example, septicemia,
pyelonephritis)
Urinary Tract Infections (UTIs)

Complicated and uncomplicated UTIs
Upper (kidney)
Lower (bladder and urethra)
Acute pyelonephritis
Acute bacterial prostatitis
Acute cystitis
Acute urethral syndrome
Recurrent urinary tract infections
Organisms That Cause UTIs

80% of uncomplicated, communityacquired UTIs: Escherichia coli
Hospital-acquired UTIs: Frequently
caused by Klebsiella, Proteus,
Enterobacter, Pseudomonas,
staphylococci, enterococci, and E. coli
Drug Therapy of UTIs
Trimethoprim/sulfamethoxazole
(TMP/SMZ) and nitrofurantoin:
Frequently the treatment of choice for
oral therapy of UTIs
Acute Cystitis
Symptoms
Dysuria, urinary urgency, urinary frequency,

suprapubic discomfort, pyuria, bacteriuria
(subclinical pyelonephritis)
Single-dose therapy
Short-course therapy (3 days)
Conventional therapy (7 days)
Acute Uncomplicated Pyelonephritis
Common in young children, older adults,

women of childbearing age
Fever, chills, severe flank pain, dysuria,

urinary frequency, urinary urgency, pyuria,
and usually bacteriuria
E. coli: Causative organism in 90% of

community-acquired infections
Mild pyelonephritis: Moderate infection

(treatment at home with oral antibiotics)
Severe pyelonephritis: Requires
hospitalization and IV antibiotics
Complicated UTI
Female and male patients with

structural or functional abnormality of
the urinary tract
Prostatic hyperplasia, renal calculi,

nephrocalcinosis, renal or bladder tumors,
ureteric stricture, or indwelling catheter
Symptoms range from mild to severe
Patient may develop systemic illness

manifesting as fever, bacteremia, and septic
shock
Recurrent UTI
Relapse
20% recolonization with the original

infecting organism
Suggests structural abnormality of urinary
tract, involvement of kidneys, or chronic
bacterial prostatitis
Reinfection
80% of recurrent UTIs in females

Usually involves lower urinary tract and may
be related to sexual intercourse
Acute Bacterial Prostatitis
Inflammation of the prostate caused by

local bacterial infection
High fever, chills, malaise, myalgia,

localized pain, dysuria, nocturia, urinary
urgency, urinary frequency, urinary
retention
80% of cases caused by E. coli
Frequently associated with indwelling
urethral catheter, urethral instrumentation,
transurethral prostatic resection
Responds well to antimicrobial therapy
10
10
Urinary Tract Antiseptics

Nitrofurantoin
Methenamine
11
11
Nitrofurantoin [Furadantin,
Macrodantin, Macrobid]
Low concentrations: Bacteriostatic
High concentrations: Bactericidal
Uses: Lower UTIs, prophylaxis, recurrent
lower UTIs
12
12
Nitrofurantoin [Furadantin]
Adverse effects
Gastrointestinal effects
Pulmonary reactions: Acute and subacute
Hematologic effects
Peripheral neuropathy: Demyelinization and
nerve degeneration can occur and may be
irreversible
Hepatotoxicity
Birth defects
Other
13
13
Methenamine [Mandelamine]
Decomposes into ammonia and
formaldehyde, which denature bacterial
proteins
Therapeutic uses
Chronic lower UTIs (TMP/SMZ is the

preferred drug)
Adverse effects
Relatively safe and generally well tolerated

Contraindicated in renal and liver failure
14
14
Methenamine [Mandelamine]
Drug interactions
Urinary alkalinizers
Sulfonamides
15
15
Question 1
Which patient does the nurse identify as most likely to
need treatment with trimethoprim/sulfamethoxazole
[Bactrim] for a period of 6 months?
A. A female patient with acute pyelonephritis
B. A male patient with acute prostatitis
C. A female patient with recurring acute urinary tract
infections
D. A male patient with acute cystitis
16
16
Question 2
Which patient would most likely need intravenous
antibiotic therapy to treat a urinary tract infection?
A. A patient with an uncomplicated urinary tract infection
caused by Escherichia coli
B. A patient with pyelonephritis with symptoms of high
fever, chills, and severe flank pain
C. A patient with acute cystitis who complains of dysuria,
frequency, and urgency
D. A patient with acute bacterial prostatitis with a mild
fever, chills, and nocturia
17
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Question 3
Which drug does the nurse identify as a urinary tract
antiseptic?
A.
B.
C.
D.
Ciprofloxacin
Ceftriaxone
Nitrofurantoin
Ceftazidime
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CH 89 Treatment For UTI

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Chapter 89

Drug Therapy of Urinary

Urinary Tract Infections (UTIs)

Older adult women in nursing homes

25% to 35% develop at least one UTI a year

Less frequent in males

Occurrence likely associated with

Urinary Tract Infections (UTIs)

Lower (bladder and urethra)

Recurrent urinary tract infections

Organisms That Cause UTIs

Drug Therapy of UTIs

Dysuria, urinary urgency, urinary frequency,

Acute Uncomplicated Pyelonephritis

Common in young children, older adults,

Fever, chills, severe flank pain, dysuria,

E. coli: Causative organism in 90% of

Mild pyelonephritis: Moderate infection

Female and male patients with

Prostatic hyperplasia, renal calculi,

Symptoms range from mild to severe

Patient may develop systemic illness

20% recolonization with the original

80% of recurrent UTIs in females

Acute Bacterial Prostatitis

Inflammation of the prostate caused by

High fever, chills, malaise, myalgia,

Urinary Tract Antiseptics

Chronic lower UTIs (TMP/SMZ is the

Relatively safe and generally well tolerated

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