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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 :

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slide1

سمينار طب داخلي

دكتر فهيمه هداوند

slide2

Uncomplicated urinary tract infection

Hadavandfahimeh

Infectious disease specialist

slide3

Classification:

  • 1) uncomplicated: cystitis and pyelonephritis in women without abnormal metabolic, anatomic disease
slide4

2) Classification:

  • cystitis and pyelonephritis in men children and women with anatomical and metabolic disease such as diabetes, neurologic bladder
slide5

Microbiology:

  • E.coli75-95% of episodes
  • Others: klebsiellapneumonia and gram postive such as staphylococcus suprophyticus, enterococcusfaecalis, streptococcus agalactiae
slide6

Uncomplicated:

  • Patient: healthy, ambulatory women with no history of anatomical or functional abnormality of the urinary tract.
slide7

Clinical:

  • Cystitis: dysuria, with or without frequency, urgency, suprapublic pain or hematuria
slide8

Pyelonephritis:

  • fever, chills, flank pain, CVAT, nausea, vomiting, with or without symptoms of cystitis.
slide9

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.
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Diagnosis:

on the basis of typical symptoms.

  • U/A and U/C is not indicated in cystitis but recommended for pyelonephritis
slide11

Assesment of pyuria and bacteruriawith dipstick

  • Pyuria: dipstick for leukocyte esterase.
  • Bacteruria: dipstick for nitrites.
  • Sensivity: 75% specifity: 82%
slide13

Antimicrobial regimen

  • First line therapy:

- nitrofurantion5 days

- Tmp-smx 3 days

- Fofomycia 3g/S.D

- pivmecillinam 400 mg BD (3-7 days)

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Side effects:

  • Nitrofuranstion: nausea, headache
  • Tmp-smx: urticaria, vomiting, photosensivity
  • Fosfomycin: diarrhea headache, vaginitis
  • Pivmecillinam: nausea, headache, diarrhea.
slide15

Second line therapy side effect

  • Fluoroquinolones: 3days insomnia, headache drowsiness
  • Betalactams (3-7 days) uriticaria
  • (e.g. co-amoxi, cefaclor) rash, vomiting
slide16

Acute uncomplicated pyelonephritis:

  • Fluroquinolones 5days
  • Tmp-smx 14days
  • Beta lactams 10-14 days
slide17

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
slide18

Antimicrobial prophylaxis

  • Three or more urinary tract infection in the past 12 months.
  • Or two or more in the past 6 months.
slide19

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
slide20

Prevention of recurrent acute uncomplicated cystitis

  • 1) nonantimicrobial
  • 2) antimicrobial
slide21

Nonantimicrobial

Behavioral:

No spermicide, urination before intercourse

Biologic:

Cranberry juice, topical estrogen.

Adhesion blocker (D-mannose)

slide22

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
slide23

Antimicrobial:

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