Urinary tract infection

2. DRUGS FOR URINARY
SYSTEM
 Urinary antiseptics
 Urinary analgesics
 Urinary acidifiers
 Urinary alkalinizers
 Urinary antibiotics

3. Urinary antiseptics -
Nitrofurantoin
 Bacteriostatic normally
 Cidal at higher concentration
 Resistance develops slowly and no cross
resistance with any other antibiotics
 Contraindicated in renal failure, pregnancy and
neonates
 Adverse effects are nausea, diarrhoea,
epigastric pain, hemolytic anemia in G-6-P-D
deficiency, peripheral neuritis.
 Used as prophylaxis during intrumentation

4. Methanamide
 Acts by releasing formaldehyde in acidic
medium and kills the bacteria
 Adverse effects are gastritis due to
formaldehyde release in stomach,
chemical cystitis, hematuria.
 Contraindicated in renal failure

5. Urinary analgesic
 Phenazopyridine an orange dye affords
symptomatic relief of burning sensation,
dysuria and urgency
 Devoid of antibacterial property.

6. Urinary acidifiers & alkalinizers
 Sodium citrate, potassium citrate,
tartaric acid
 Sodium bicarbonate, acetazolamide
Acidic Alkaline pH immaterial
Nitrofurantoin Cotrimoxazole Chloramphenicol
Methanamine Aminoglycosides Ampicillin
Tetracyclines Cephalosporins
Cloxacillin Fluoroquinolones

7. Antibiotics for urinary tract infections
 In acute cystitis Cotrimoxazole 4 tablets
given as a single dose
 In upper / lower UTI a course of 3-
10days
 Fluoroquinolones and cotrimoxazole are
contraindicated in pregnant women.

8. Cotrimoxazole:
 Coliform bacteria including E-coli and
Proteus mirabilis are susceptible
 Acute but uncomplicated cases respond
rapidly
 A course of 5-10 days is effective mostly
 Single dose therapy only in case of
acute cystitis

9. Fluoroquinolones:
 1st generation fluoroquinolones are commonly
used
 Norfloxacin among the other 1st generation
drugs are concentrated more in urinary tract,
genital tract and git.
 Pseudomonas and gram positive cocci doesn’t
respond to norfloxacin.
 Ofloxacin a better action against gram positive
organisms and chlamydia and mycoplasma.
 Ciprofloxacin is used commonly for git
infections

10. Cephalosporins:
 Cephelexin, cefixime and cefpodoxime
proxetil are commonly used in urinary
tract infections
 They are excreted unchanged by kidney
and hence preferred in urinary tract
infections
 Effective against gram positive
organisms (cocci and bacilli)
 Preferred in pregnant women presenting
with UTI

11. Penicillins & Penicillin +
Clavulanic acid
 Used in case of susceptible gram
positive infection after culture sensitivity
report
 Commonly used drugs are amoxicillin,
ampicillin, etc,.
 In case of pyelonephritis pipericillin is
effective when sensitive organisms are
causative.

12. Antimicrobial regimens for acute
UTI(given orally for 3-5 days)
 Norfloxacin 400mg 12th hourly
 Ciprofloxacin 250-500mg 12th hourly
 Ofloxacin 200-400mg 12th hourly
 Cotrimoxazole 960mg 12th hourly
 Cephalexin 250-500mg 6th hourly
 Cefpodoxime proxetil 200mg 12th hourly
 Amoxicillin + Clavulanic acid (500+125mg)
8th hourly
 Nitrofurantoin 50mg 8th hrly or 100mg 12th
hrly for 5-7 days.

13. Cont….
 Cloxacillin in pencillinase producing staph
infections
 Piperacillin / Carbenicillin in serious
Pseudomonas infection.
 Gentamicin for Pseudomonas infection and
combined with co-amoxiclav.
 Cephalosporins for recurrent cystitis when
women likely to get pregnant.
 Chloramphenicol restricticed to pyelonephritis
and with positive sensitive report
 Tetracyclines in Ch.trachomatis cystitis.

14. Urinary infection in patients with
renal impairment
Drugs contraindicated and avoided in renal failure
 Methenamine
 Tetracyclines
 Cephalosporins
 Nitrofurantoin
 Nalidixic acid
 Aminoglycosides
 Potassium salts and acidifying agents
Bacteriological testing and follow up cultures are a must
to select the appropriate drug and to ensure
eradication of the pathogen.

15. Prophylaxis for UTI
 Women of child bearing age have
recurrent cystitis
 Catheterization or Instrumentation
 Indewelling catheters are placed
 Uncorrectable abnormalities of the
urinary tract
 Inoperable prostate enlargement

16. Drugs for Prophylaxis of UTI
The following drugs are given once daily at
bed time
 Cotrimoxazole 480mg
 Nitrofurantoin 100mg
 Norfloxacin 400mg
 Cephalexin 250mg

17. Thank you

18. Laxatives , Purgatives , Cathartics
Mechanism of Action
 Laxatives modify the fluid dynamics of
the mucosal cell and may cause fluid
accumulation in gut lumen by
 Inhibiting NaKATPase of villous cells
 Stimulating adenylyl cyclase in crypt cell
 Enhancing PG and NO synthesis
 Structural injury to absorbing intestinal
mucosal cells

19. Purgatives MOA
 Hydrophilic and osmotic action, retaining
water and electrolytes in the lumen,
increase volume of colonic content and
make it easily propelled
 Reduces absorption and enhanced
transit in intestine
 Primary action is to increase propulsive
activity

20. Classification of drugs
 Bulk forming
Dietary fibre: Bran, Ispaghula, Psyllium
 Stool softner
Liquid paraffin, Docusates
 Stimulant purgatives
Diphenylmethanes, anthraquinones, 5-
HT4 antagonist(Prucalopride), Fixed Oil
 Osmotic purgatives
Magnesium & sodium salts, Lactulose

21. Choice & Use of Purgatives
 Functional constipation
 Bedridden patients
 To avoid straining at stools
 Preparation of bowel for surgery,
colonoscopy, abdominal x-ray
 After certain antihelmintics
 Food / drug poisoning

22. Purgative abuse
 Flairing of intestinal pathology, rupture of
inflammed appendix
 Fluid and electrolyte imbalance,
especially hypokalaemia
 Steatorrhoea, Malabsorption syndrome
 Protein losing enteropathy
 Spastic colitis