Lectures on the treatment of urinary tract infections (UTI)

2021-08-11 04:31 PM

When UTI is accompanied by an abnormality of the anatomy, or function of the urinary apparatus, such as urinary catheter, stones, urinary tract infection after surgery.

General principles

Prior to drug therapy, a urine culture must be obtained.

Choose antibiotics appropriately, consistent with the results of the antibiogram, use the most effective antibiotic and the least nephrotoxic.

Treatment duration is 3-5 days for simple infections. Complicated infections can be treated for weeks, especially recurrent UTIs can be treated for many months.

After a course of treatment, it is necessary to follow up with a urine culture after 3 weeks, 6 weeks, after 3 months, test the urine again to detect recurrence.

In addition, the cause must be treated: urolithiasis, pressure tumor, congenital deformity causing recurrent urinary tract infections.

Common causes

Simple form

Acute cystitis in young women: Ecoli accounts for 90% of cases. The frequency of cystitis is not more than 4 times a year. The rate of the disease in women is 50 times higher than that in men (20-30 % of adult women have one time of cystitis). 30 years of age are often recurrent, 80% of recurrent infections are caused by bacterial reinfection from the perineum.

Patients with painful urination, frequent urination sometimes feel pain in the perineum or blood in the urine.

Two important negative symptoms are no fever and no back pain.

“Minute” treatment is the strategy of choice:

Select antibiotic: apply to acute cystitis in young women, no history of urological disease, onset < 3 days: Drugs that can be used as a single dose:

Trimethoprim (Bactrim 480mg 3 tablets single dose).

Ciprofloxacin (Uniflex 1vienn / 1lần / 1ngày).

Pefloxacine (Péflacine monodose 2 tablets 400mg).

Contraindicated recurrent cystitis and pregnant women.

Short-term treatment (3-5 days):

This regimen replaces the classic 10-day treatment.

Its benefits are ease of monitoring and better loading, better efficacy, single-dose, broader indications, this type of treatment is suitable for elderly women as well as young women.

All antibiotics given in the urine can be used for short-term treatment.

This type of treatment is chosen for “blind” prescription when an antibiogram is not available.

Cotrimoxazole: Bactrim Forte 960mg 1v x 2 times/day (oral).

Péfloxacine: Péflacine 1v=400mg x 2 times/day (oral).

Ciprofloxacin: Uniflex.

Fluoroquinolone.

Lactam drugs should not be used in acute cystitis because of their short half-life.

Treatment of severe cases

Complicated cystitis

When UTI is accompanied by an anatomical or functional abnormality of the urinary apparatus such as urinary catheters, stones, urinary tract infections after surgery, polycystic kidney disease, cystitis in men, diabetes. or leukopenia...Intestinal bacilli such as Ecoli only see 70% of cases. Other bacteria such as: Proteus, Klebsiella, Staphylococus aureus

Acute pyelonephritis

Usually due to retrograde ureteral infection rather than sepsis

Clinical symptoms: including back pain on one side of the renal fossa, fever > 38o5 with chills. The disease is common in women. In men, febrile urinary tract infections are often caused by acute prostatitis.

It is usually caused by gram-negative bacilli, mainly Ecoli.

Treatment:

The patient must be completely rested and drink plenty of water (> 2l/day) to urinate more and flush the urinary system.

Use antibiotics that are concentrated in the blood and those with high concentrations in the urine, which kill bacteria.

The two groups of antibiotics most used are:

3rd generation cephalosporins (From 1980 onward), should initially be given intravenously, or intramuscularly or PIV.

The average treatment time after the fever is stopped is 10-15 days.

If there are complications such as kidney abscess, or prostatitis, treatment should be continued for at least 1 to 2 months. Long-term treatment must be indicated in case of aggravation of the disease.

Specific treatment:

Claforan 1g IM every each 8h.

Ceftriaxone (Rocephin IM hay IV 2g/ 24h).

Fluoroquinolones are administered orally because of their high bioavailability.

Attention: Quinolone-resistant Ecoli is now on the rise.

Pefïlacine 1 tablet = 400mg.

Pélox 1 tablet = 400mg (oral) 1 tablet x 2 times/day.

Two-antibiotic therapy may be indicated in the first 48 hours, including:

Aminoglycosides as a single daily dose intramuscularly.

Gentamycin: 3mg/kg/24h intramuscularly.

Combination with 3rd generation Cephalosporine or Fluoroquinolone.

Aim to achieve maximum bactericidal capacity in the early critical period and to kill strains of bacteria that are resistant to other antibiotics, if any.

Special cases

Complications

The cause must be treated and always combined with long-term antibiotic therapy.

Recurrence 

Recurrent cystitis:

Maintain urinary tract hygiene.

Prophylactic antibiotics continuously or intermittently with modified antibiotics suitable for treatment.

Commonly used groups:

1st generation cephalosporins (from 1965 to 1980) low dose (maximum = 1/2 daily dose) such as:

Cephalexin 0.5g 1-2 tablets/day orally, to reduce the adhesion of bacteria to the bladder wall.

Duration of treatment < 1 year.

Oral quinolones can be used such as:

Nitrofurantoin (Furadantin 1 tablet = 100mg orally 1 tablet / night before going to bed).

The above-mentioned prophylactic antibiotics are used daily or treated 2-3 days/week to still have enough effective antibiotic concentrations in the urine to combat bacterial adhesion to the bladder epithelium.

Urinary tract infections in pregnant women

Sometimes prompt treatment and appropriate antibiotics such as:

Ampicillin, Cephalosporine can be used in the first 3 months, 2nd trimester, 3rd trimester of pregnancy.

Nitrofurantoin (Furadantin 1 tablet = 100mg orally in the evening should be used during the second trimester of pregnancy.

Urinary tract infections in the elderly and men

Asymptomatic UTIs are associated with internal changes in women or urethral obstruction due to an enlarged prostate in men, the frequency of which increases with age.

The condition can be diagnosed as cystitis or pyelonephritis. Sometimes symptoms only show a simple fever, can die from septic shock, meningitis....

Urinary tract infection in the elderly with diabetes, bedridden, neurological disorders, urinary catheter. In men, a rectal examination is required to diagnose prostatitis.

Must do cytology, bacteriuria and make antibiogram for appropriate and timely treatment.

Note: Tuberculosis can cause white blood cell count without bacteria.

Specific treatment of each case according to the protocol as mentioned above