سمينار طب داخلي

1. سمينار طب داخلي دكتر فهيمه هداوند

2. Uncomplicated urinary tract infection Hadavandfahimeh Infectious disease specialist

3. Classification: • 1) uncomplicated: cystitis and pyelonephritis in women without abnormal metabolic, anatomic disease

4. 2) Classification: • cystitis and pyelonephritis in men children and women with anatomical and metabolic disease such as diabetes, neurologic bladder

5. Microbiology: • E.coli75-95% of episodes • Others: klebsiellapneumonia and gram postive such as staphylococcus suprophyticus, enterococcusfaecalis, streptococcus agalactiae

6. Uncomplicated: • Patient: healthy, ambulatory women with no history of anatomical or functional abnormality of the urinary tract.

7. Clinical: • Cystitis: dysuria, with or without frequency, urgency, suprapublic pain or hematuria

8. Pyelonephritis: • fever, chills, flank pain, CVAT, nausea, vomiting, with or without symptoms of cystitis.

9. Dysuria is common with urethritisor vaginitis. But cystitis is more likely when symptons include frequency, argency, or hematuria. • When the onst is sudden or severe.

10. Diagnosis: on the basis of typical symptoms. • U/A and U/C is not indicated in cystitis but recommended for pyelonephritis

11. Assesment of pyuria and bacteruriawith dipstick • Pyuria: dipstick for leukocyte esterase. • Bacteruria: dipstick for nitrites. • Sensivity: 75% specifity: 82%

12. Urine culture:105 CFU per milliliter

13. Antimicrobial regimen • First line therapy: - nitrofurantion5 days - Tmp-smx 3 days - Fofomycia 3g/S.D - pivmecillinam 400 mg BD (3-7 days)

14. Side effects: • Nitrofuranstion: nausea, headache • Tmp-smx: urticaria, vomiting, photosensivity • Fosfomycin: diarrhea headache, vaginitis • Pivmecillinam: nausea, headache, diarrhea.

15. Second line therapy side effect • Fluoroquinolones: 3days insomnia, headache drowsiness • Betalactams (3-7 days) uriticaria • (e.g. co-amoxi, cefaclor) rash, vomiting

16. Acute uncomplicated pyelonephritis: • Fluroquinolones 5days • Tmp-smx 14days • Beta lactams 10-14 days

17. 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

18. Antimicrobial prophylaxis • Three or more urinary tract infection in the past 12 months. • Or two or more in the past 6 months.

19. Follow up • Cystitis and pyelonephritis is not recommended but persistanthematuria or multiple early recurrences. • in pyelonephritis when fever 48 to 72 h after treatment or severe or worsening illness

20. Prevention of recurrent acute uncomplicated cystitis • 1) nonantimicrobial • 2) antimicrobial

21. Nonantimicrobial Behavioral: No spermicide, urination before intercourse Biologic: Cranberry juice, topical estrogen. Adhesion blocker (D-mannose)

22. 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

23. Antimicrobial: • Nitrofurantion: 50-100 mg • Tmp-smx: 40mg and 200 mg • Tmp: 100 mg • Cephalexin:125-250

24. Thanks for your attension