Treatment For UTI !!!

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Treatment For UTI !!!

Post by k.pravalika on Mon Jun 25, 2012 2:57 pm

What is the standard protocol for treating UTI ?

What are the first line drugs and for how much duration they should be prescribed??

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Re: Treatment For UTI !!!

Post by rituparnamaiti on Mon Jun 25, 2012 5:04 pm

First line drugs:
1] Fluoroquinolones,
2] Extended spectrum penicillin,
3] Cephalosporins
4] Cotrimoxazole

Treatment Principles
Acute cases:
Urine sampling followed by Empirical therapy
Substitution if necessary
Chronic cases:
Mixed infection ± Renal failure
Thorough investigations and then treatment.
Factor predisposing like calculi, obstruction should be corrected.

Treatment of LUTI
1] Acute uncomplicated cystitis / urethritis
Short course (3 – 7 day) of [Ref: Harison 18th Ed. Table 288-1]
1)Cotrimoxazole 2 tab b.i.d.
2)Cephalexin 500mg q.i.d.
3)Ampicillin 250-500mg q.i.d.
4)Norfloxacin 400mg b.i.d.[/list]

7-14 days treatment is required If patient is diabetic , symptoms >7days, >65 years, Pregnancy, Failure of 3 day treatment

2] Chronic persistent LUTI
Commonly with indwelling catheter

7 – 14 day antimicrobial therapy
+
Bladder wash with 1:10000 Chlorhexidine

3] Recurrent Infection
Repeated bacteriuria within one month of apparently successful treatment
4-6 week treatment with
1)Cotrimoxazole or Fluoroquinolones
2)Amoxicillin + Clavulinic acid

4] Post-coital cystitis
0.5% Cetrimide to apply to periurethral area
Single dose of Ampicillin 250mg / Cotrimoxazole after each coitus

Treatment of UUTI
1] Acute Pyelonephritis
Associated with predisposing factors
Urine and blood culture must before treatment
Drug treatment for 14 days:
1)Ampicillin 1-2g i.v. / orally
2)Cephalosporin
3)Cotrimoxazole

if fever / flank pain persists after 3 days
Repeat urine culture
USG to rule out abscess

If severely ill / hospitalized
III rd generation Cephalosporin
Ampicillin + Gentamicin
Imepenem + Cilastin

2] Chronic Pyelonephritis
May lead to chronic renal failure
Underlying cause (obstruction) searched for
Choice of drug: according to sensitivity report

Follow Up
Acute UTI:
6 months
Urine cultures should be repeated 1-2 monthly
Recurrent acute / Chronic UTI:
Follow up cultures for 2 years

Prophylaxis with Cotrimoxazole / Ampicillin
1] Following instrumentation of urinary tract
2] Uncorrectable congenital anomalies
3] >3 symptomatic UTI attacks
4] Chronic Prostatitis
5] Pregnant women with asymptomatic bacteriuria


Dear Dr. Pravalika, Here I have mentioned standard book protocol. You'll get practical guidance from your clinical teachers. If you find any new/modified guideline, please add here.




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Re: Treatment For UTI !!!

Post by k.pravalika on Wed Jun 27, 2012 5:43 pm

thankyou sir.

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