سمينار طب داخلي
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سمينار طب داخلي. دكتر فهيمه هداوند. Uncomplicated urinary tract infection Hadavand fahimeh Infectious disease specialist. Classification : 1) uncomplicated: cystitis and pyelonephritis in women without abnormal metabolic, anatomic disease. 2) Classification : - PowerPoint PPT PresentationTRANSCRIPT
سمينار طب داخلي
هداوند فهيمه دكتر
Uncomplicated urinary tract
infection
Hadavand fahimeh
Infectious disease specialist
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.
Clinical:
Cystitis: dysuria, with or without
frequency, urgency, suprapublic
pain or hematuria
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%
Urine culture:105 CFU per milliliter
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
Acute uncomplicated pyelonephritis: Fluroquinolones 5days Tmp-smx 14days Beta lactams 10-14 days
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
Prevention of recurrent acute
uncomplicated cystitis
1) nonantimicrobial
2) antimicrobial
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
Antimicrobial:
Nitrofurantion: 50-100 mg
Tmp-smx: 40mg and 200 mg
Tmp: 100 mg
Cephalexin:125-250
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