دانشگاه صنعتي اميركبير دانشكده مهندسي پزشكي استاد درس دكتر فرزاد توحيدخواه بهمن 1389
دكتر فهيمه هداوند. Uncomplicated urinary tract infection Hadavand fahimeh Infectious...
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Transcript of دكتر فهيمه هداوند. Uncomplicated urinary tract infection Hadavand fahimeh Infectious...
Classification:
1) uncomplicated: cystitis and
pyelonephritis in women without
abnormal metabolic, anatomic
disease
2) Classification:
cystitis and pyelonephritis in men
children and women with
anatomical and metabolic disease
such as diabetes, neurologic
bladder
Microbiology:
E.coli 75-95% of episodes
Others: klebsiella pneumonia and gram
postive such as staphylococcus
suprophyticus, enterococcus faecalis,
streptococcus agalactiae
Uncomplicated:
Patient: healthy, ambulatory women
with no history of anatomical or
functional abnormality of the
urinary tract.
Pyelonephritis:
fever, chills, flank pain, CVAT,
nausea, vomiting, with or without
symptoms of cystitis.
Dysuria is common with urethritis or
vaginitis. But cystitis is more likely
when symptons include frequency,
argency, or hematuria.
When the onst is sudden or severe.
Diagnosis:
on the basis of typical symptoms.
U/A and U/C is not indicated in
cystitis but recommended for
pyelonephritis
Assesment of pyuria and bacteruria
with dipstick
Pyuria: dipstick for leukocyte
esterase.
Bacteruria: dipstick for nitrites.
Sensivity: 75% specifity: 82%
Antimicrobial regimen
First line therapy:
- nitrofurantion 5 days
- Tmp-smx 3 days
- Fofomycia 3g/S.D
- pivmecillinam 400 mg BD (3-7 days)
Side effects:
Nitrofuranstion: nausea, headache
Tmp-smx: urticaria, vomiting, photosensivity
Fosfomycin: diarrhea headache, vaginitis
Pivmecillinam: nausea, headache, diarrhea.
Second line therapy side effect
Fluoroquinolones: 3days
insomnia,
headache drowsiness
Betalactams (3-7 days) uriticaria
(e.g. co-amoxi, cefaclor) rash, vomiting
Recurrent cystitis
Relaps: time (one or two week after cystitis)
Treatment: board spcctrum AB. Such as
fluoroquinolone.
Reinfection: at least 1 month after cystitis
Treatment: first line short course regimen
Antimicrobial prophylaxis
Three or more urinary tract
infection in the past 12 months.
Or two or more in the past 6
months.
Follow up
Cystitis and pyelonephritis is not
recommended but persistant
hematuria or multiple early
recurrences.
in pyelonephritis when fever 48 to
72 h after treatment or severe or
worsening illness
Nonantimicrobial
Behavioral:
No spermicide, urination before intercourse
Biologic:
Cranberry juice, topical estrogen.
Adhesion blocker (D-mannose)
Antimicrobial
Self diagnosis and self treatment: u.c
be obtained periodically for confirme
and susceptibilities
Antimicrobial prophylaxis.
Postcoital: single dose
Continuous: daily bed time dose: for six
month