1. Urinary Tract Infection

2. Urinary Tract Infection (UTI)
• UTI is the 2nd
most common infectious
presentation in community practices
• World wide, about 150 million people are
diagnosed with UTI each year
Ann Clin Micr Anti 2007;6:4-12

3. UTI is an inflammatory response of
the urothelium to bacterial invasion
Campbells Urology 2007; 9th
Ed
Urinary Tract Infection (UTI)
UTI can occur in females and males,
in all age groups

4. Prevalence
35% of healthy women suffer symptoms of UTI at some
time in their life
Common in women
Medicine 2007;35:423-427

5. Why greater susceptibility of
UTI in women?
The female urethra
• short length (~4cm)
• proximity to anus
Urethra is prone to colonization with bacteria
(Fecal bacteria)
Medicine 2007;35:423-427

6. Prevalence
• Rare in Males
• Anatomical or functional abnormality of
the urinary tract
8% of girls and 2% of
boys will have UTI in
childhood
• Increases in elderly
• 21% of women and 12% of men over
65 yrs of age have UTI
Medicine 2007;35:423-427
BMJ 1999;319:1173-1175

7. Pathogenesis
Most UTI occur in women who are healthy
Interaction between the bacterial virulence
and host defence
Increase in
virulence
Decrease in
host defence
Infection+
Medicine 2007;35:423-427

8. Routes of Infection
Common route
– Ascending through urethra
Other route
– Blood and lymphatic
EAU Guidelines 2006

9. UTI
Community acquired
UTI
Nosocomial
UTI
UTI - Classification
EAU Guidelines 2006

10. Uncomplicated UTIs Complicated UTIs
Infection involving normal
urinary tract
Presence of metabolic,
anatomic and functional
abnormalities
UTI
UTI - Classification
EAU Guidelines 2006
Healthy non-pregnant women
• Pregnancy
• Catheterization
• Diabetes
• Infection stones

11. Site of origin
Epididymitis
Prostatitis
Pyelonephritis
Cystitis
Urethritis
UTI - Classification
Orchitis
EAU Guidelines 2006

12. Risk factors associated with UTIs
Uncomplicated Complicated
• Sexual intercourse
• Spermicide creams
• Diaphragm
• Previous UTI
• Pregnancy
• Catheterization
• Diabetes
• Infection stones
• Male
• Elderly
Medicine.2007;35:423-427

13. Clinical presentation of
Uncomplicated UTI
Common symptomatic infection in young
non-pregnant women is uncomplicated
cystitis
• Asymptomatic bacteriuria
• Acute Cystitis
• Acute Pyelonephritis
EAU Guidelines 2006

14. Causative organisms
Acute Uncomplicated cystitis
E.Coli : 70- 95%
Staphylococcus.saprophyticus :10-15%
Klebsiella species
Proteus mirabilis
Arch Intern Med.2007;167:2207-12

15. Causative organisms
Acute Uncomplicated pyelonephritis
E.Coli – 80%
Klebsiella species
Proteus mirabilis
Other enterobacteria
Staphylococcus aureus
Prim Care Clin Office Pract 2008;35:345-367

16. Symptoms of
Uncomplicated cystitis
If both dysuria and frequency present
in the absence of vaginal
discharge, the chance of UTI is ~90%
• Dysuria
• Frequency
• Urgency
• Hematuria
• Suprapubic pain
Campbells Urology 2007; 9th
Ed

17. Symptoms of
Uncomplicated pyelonephritis
• Fever
• Flank pain
• Nausea
• Vomiting
• Abdominal pain
The patient may or may not have
symptoms of cystitis
Prim Care Clin Office Pract 2008;35:345-367

18. Diagnosis
History
• Symptoms of UTI
• Other History (eg. Vaginal discharge)
Examination
Pelvic examination to rule out other causes like
urethritis and vaginitis
EAU Guidelines 2006

19. Diagnosis
Urine Analysis
-Dipstick method
• Nitrite
• Leukocyte esterase
- Microscopic analysis
• Bacteriuria
• Pyuria
• Hematuria
EAU Guidelines 2006

20. Diagnosis
Urine Culture
Not recommended in case of cystitis but done
if pyelonephritis suspected or complicated UTI
Ultrasonography
CT scan
EAU Guidelines 2006

21. Treatment for Uncomplicated Cystitis
Short term antibiotics
( EAU recommendation - Drugs of
first choice)
Drug Dose Duration
NitrofurantoinNitrofurantoin
macrocrystalsmacrocrystals
100mg, bid100mg, bid 5-7days5-7days
Fosfomycin
trometamol°
1 day
3 g SD 1day1day
Pivmecillinam
Pivmecillinam
400 mg bid
200 mg bid
3 days
7 days
EAU Guidelines 2010

22.  Ciprofloxacin 250 mg bid 3 days (CIPLOX)
 Levofloxacin 250 mg qd 3 days (LEVOFLOX)
 Norfloxacin 400 mg bib 3 days (NORFLOX)
 Ofloxacin 200 mg bid 3 days
 Cefpodoxime proxetil 100 mg bid 3 days (CEFOPROX)
 If local resistance pattern is known (E. coli resistance <
20%):
 Trimethoprim–sulphamethoxazole 160/800 mg bid
3 days
 Trimethoprim 200 mg bid 5 days
Treatment for Uncomplicated Cystitis
(Alternatives)
EAU Guidelines 2010

23.  Oral therapy in mild and moderate cases
 Ciprofloxacin 500–750 mg bid 7–10 days
 Levofloxacin 250–500 mg qd 7–10 days
 Levofloxacin 750 mg qd 5 days
 Alternatives (clinical but not microbiological equivalent efficacy
compared with fluoroquinolones):
 Cefpodoxime proxetil 200 mg bid 10 days
 Ceftibuten 400 mg qd 10 days
 Only if the pathogen is known to be susceptible (not for initial
empirical therapy):
o Trimethoprim–sulphamethoxazole 160/800 mg bid 14 days
o Co-amoxiclav 0.5/0.125 g tid 14 days
Treatment for Uncomplicated Pyelonephritis
Recommendations as per EAU guidelines
EAU Guidelines 2010

24. Treatment for Uncomplicated Pyelonephritis
In severe cases of pyelonephritis
• Hospitalization
• Parenteral antibiotics (Quinolones and
beta lactamase inhibitor)
• With improvement switch to oral therapy to
complete the course
EAU Guidelines 2006

25. Choice of antibiotics should take into account
not only the spectrum of activity
but also resistance

26. Susceptibility Patterns ofSusceptibility Patterns of E.ColiE.Coli from 2003-2007from 2003-2007
International dataInternational data
0
20
40
60
80
100
120
E.coli-2003 E.Coli-2004 E.Coli-2005 E.Coli-2006 E.Coli-2007 Average
TMP/Sulfa
Ciprofloxacin
Levofloxacin
Nitrofurantoin
%Susceptability
J Urol 2008;178:84
E.coli has highest susceptibility for
Nitrofurantoin

27. Susceptibility patterns of E.coli to various
antibiotics : Indian data
0
10
20
30
40
50
60
70
80
90
100
T/S A Nx Cf G Ce Ci Nf
T/S- Trimethoprim/Sulfamethoxazole; A- Ampicillin; Nx-Norfloxacin;
Cf-Ciprofloxacin; G-Gentamicin; Ce-Cefotaxime; Ci-Ceftriaxone; Nf-Nitrofurantoin
Indian J Med Sci 2006;60:53-58
E.coli has highest susceptibility for
Nitrofurantoin

28. Resistance
• Infecting organisms are not susceptible to
antimicrobial agent selected
• Invariably patient has received recent
antimicrobial therapy which produces resistance
Campbells Urology 2007; 9th
Ed

29. Incidence of recurrenceIncidence of recurrence
• One in four women will develop recurrence
• 27% of women will experience a recurrence
within 6-12 months
Best Pract Res Clin Obstet Gynaecol 2005;19:861-873

30. Resistance rates in E coli: International data
38
21
6
1
0
5
10
15
20
25
30
35
40
Ampicillin TMP-SMX Cipro Nitro
ResistanceratesinEcoli%
Urol Clin Am;2008:35:69-79
Nitrofurantoin has least resistance compared to
other commonly used antibiotics

31. Resistance to TMP-SMX is more than 75%
Resistance rates in E coli: Indian data
More than 80% of the fluoroquinolone
resistant strains were found to be
sensitive to Nitrofurantoin
Indian J Med Sci 2006;60:53-58
Resistance to Fluoroquinolones is as
high as 69%
Prim Care Clin Office Pract 2008;35:345-367

32. Follow-up
Urine Analysis
- Bacteriuria
Urine culture
- If symptoms do not resolve or recur within 2 weeks
EAU Guidelines 2006

33. Recurrence
Recurrent UTI is defined as 3 episodes of UTI
in the last 12 months or 2 episodes in the
last 6 months
Recurrent UTI occur in 20-25% of women
Risk Factors
 History of UTI in mother
 Behavioural factors
- Frequency of sexual intercourse
- Spermicide cream
- Diaphragm EAU Guidelines 2006
Medicine.2007;35:423-427

34. Prophylaxis for Recurrent UTI
Pharmacological
- Antibiotic prophylaxis
Non Pharmacological
- Voiding after intercourse
- Cranberry juice
- Alkalizer (Potassium citrate)
EAU Guidelines 2006

35. Antibiotic prophylaxis
Long term prophylactic antimicrobials
- Taken regularly at bedtime
Post coital prophylaxis
- When related to sexual intercourse
95% decrease in UTI episodes/pt year
EAU Guidelines 2006

36. EAU Guidelines 2010
Long term prophylactic antimicrobials
Taken at bedtime
Drug Dose
NitrofurantoinNitrofurantoin 50/100mg/day50/100mg/day
TMP-SMXTMP-SMX 40/200mg/day or three times weekly40/200mg/day or three times weekly
CefaclorCefaclor 250mg/day250mg/day
CephalexinCephalexin 125/250mg/day125/250mg/day
NorfloxacinNorfloxacin 200mg/day200mg/day
CiprofloxacinCiprofloxacin 125mg/day125mg/day
Fosfomycin 3 g every 10 days

37. Post coital prophylaxis
EAU Guidelines 2010
Drug Dose
TMP-SMXTMP-SMX 40/200mg40/200mg
NitrofurantoinNitrofurantoin 50/100mg50/100mg
CephalexinCephalexin 250mg250mg
CinoxacinCinoxacin 250mg250mg
CiprofloxacinCiprofloxacin 125mg125mg
NorfloxacinNorfloxacin 200mg200mg
OfloxacinOfloxacin 100mg100mg

38. 0
10
20
30
40
50
60
70
80
90
Noofpatients
No of symptomatic episodes
Long term prophylaxis with nitrofurantoin
for 1year (18 years of experience)
Significantly higher no of patients had no
symptomatic episodes of UTI
J Antimicrob Chemother.1998;42: 363-371
0 1 2 3 4 5 6 7 8

39. Nitrofurantoin has maintained its place
in the treatment of UTI due to least
resistance

40. Different forms of Nitrofurantoin
• Nitrofurantoin Microcrystalline
- Introduced in 1953
• Nitrofurantoin Macrocrystals
- Introduced in 1968
• Nitrofurantoin Monohydrate/Macrocrystals
- Novel formulation
J Antimicrob Chemother.1998;42: 363-371

41. Nitrofurantoin Microcrystalline form had
Limitations like
Nitrofurantoin Macrocrystalline form superior
to Nitrofurantoin Microcrystal form
- Severe GI side effects like nausea and vomiting
- Four times daily dosing
- Better GI tolerability
Nitrofurantoin Monohydrate/Macrocrystal superior
to both
- Better GI tolerability
- BID dosing
J Antimicrob Chemother.1998;42: 363-371

42. 0
10
20
30
40
50
60
70
BID QID
Compliance(%)
BID dosing associated with significantly
better compliance than QID dosing
Nitrofurantoin
monohydrate/macrocrystals
Nitrofurantoin
microcrystalline
J Antimicrob Chemother.1998;42: 363-371

43. Nitrofurantoin Monohydrate/Macrocrystals
provides BID dosing and
retains the efficacy and safety profiles
of Nitrofurantoin macrocrystals
J Antimicrob Chemother.1998;42: 363-371

44. Complicated UTI
• Pregnancy
• Diabetes
• Paediatric UTI
• Catheter associated urinary tract infection (CAUTI)
• Prostatitis

45. UTI in PregnancyUTI in Pregnancy

46. Pregnancy
UTIs are detected in 2 to 8% of pregnant women
Clinical presentation
• Asymptomatic
• Symptomatic
- Cystitis
- Pyelonephritis
Risks
- Low birth weight baby
- Low gestational age (<37 weeks) and Prematurity
- Neonatal mortality
EAU Guidelines 2006

47. Recommended treatment regimens for asymptomatic
bacteriuria and cystitis in pregnancy
Antibiotic Comments
Nitrofurantoin monohydrate / macrocrystals Avoid in G6PD deficiency
100 mg q12 h, 3–5 days
Amoxicillin Increasing resistance
500 mg q8 h, 3–5 days
Co-amoxicillin/clavulanate
500 mg q12 h, 3–5 days
Cephalexin 500 mg q8 h, 3–5 days Increasing resistance
Fosfomycin 3 g Single dose
Trimethoprim–sulfamethoxazole Avoid trimethoprim in
q12 h, 3–5 days first trimester/term and
sulfamethoxazole in
third trimester/term
EAU Guidelines 2010

48. Recommended treatment regimens for
pyelonephitis in pregnancy
 Ceftriaxone 1–2 g IV or IM q24 h
 Aztreonam 1 g IV q8–12 h
 Piperacillin–tazobactam 3.375–4.5 g IV q6 h
 Cefepime 1 g IV q12 h
 Imipenem–cilastatin 500 mg IV q6 h
 Ampicillin 2 g IV q6 h + gentamicin 3–5 mg/kg/day IV in
3 divided doses
Outpatient management with appropriate antibiotics
should be considered provided symptoms are mild and
close follow-up is feasible

49. UTI in DiabetesUTI in Diabetes

50. Diabetes
Prevalence of UTI is 26% in women with diabetes
compared with 6% in those without diabetes
Clinical presentation
• Asymptomatic
• Symptomatic
- Cystitis
- Pyelonephritis
Risks
Upper tract involvement in diabetes (pyelonephritis) is 5-fold
more frequent than in non diabetics and can lead to serious
complications like:
• Renal and perinephric abscess
• Papillary necrosis
Int J Anti Agents 2000;15: 247-256

51. Diabetes
Causative organisms
E.Coli - 75%
Klebsiella
Enterobacter
S.faecalis
Fungi
Int J Anti Agents 2008;31S:S54-S57

52. Asymptomatic: Screening and treatment not warranted
Treatment for UTI in diabetic patients
Symptomatic:
• Long term antibiotics (7-14 days)
- Amoxicillin
- Nitrofurantoin
-TMP/SMX
- Ciprofloxacin
• Choice of antimicrobials is similar in diabetic and
non diabetics
• Commonly prescribed antibiotics
• TMP/SMX is not a good first choice as in addition to high
resistance it can lead to hypoglycemia
Int J Anti Agents 2008;31S:S54-S57

53. Paediatric UTIPaediatric UTI

54. UTI in Children

55. Incidence of pediatric UTI
Pediatr Clin N Am 2006;53:379-400
Age (Y)Age (Y) Female (%)Female (%) Male (%)Male (%)
< 1< 1 0.70.7 2.72.7
1- 51- 5 0.9-1.40.9-1.4 0.1- 0.20.1- 0.2
6-166-16 0.7- 2.30.7- 2.3 0.04- 0.20.04- 0.2

56. Risk factors for pediatric UTI
• Neonate /Infant
• Urinary tract anomalies (Vesicoureteral reflux)
• Functional abnormalities (Neurogenic bladder)
• Immunocompromised states
Pediatr Clin N Am 2006;53:379-400

57. Clinical presentation
Pediatric UTI
• Asymptomatic
• Symptomatic
- Cystitis
- Pyelonephritis
Risks
• Poor renal growth
• Recurrent pyelonephritis
• Hypertension
• End Stage Renal Disease (ESRD)
Pediatr Clin N Am 2006;53:379-400

58. Classification of pediatric UTI
Urinary Tract Infection
First Infection Recurrent Infection
Unresolved
Bacteriuria
Bacterial
Persistance
Reinfection
Pediatr Clin N Am 2006;53:379-400

59. Classification of pediatric UTI
Severe UTI Simple UTI
Fever ≥ 39°CFever ≥ 39°C Mild pyrexiaMild pyrexia
Persistent vomitingPersistent vomiting Good fluid intakeGood fluid intake
Serious dehydrationSerious dehydration Slight dehydrationSlight dehydration
EAU Guidelines 2006

60. Diagnosis of pediatric UTI
Physical Examination
+
Urinalysis/Urine culture
> 2 UTI episodes
in girls
> 1 UTI episodes
in boys
Imaging tests
EAU Guidelines 2006

61. Treatment of pediatric UTI
Severe UTI Simple UTI
Parental therapy until
afebrile
• Adequate hydration
• Cephalosporins
(3rd generation)
• Amoxycillin/clavulanate
if cocci are present
Oral therapy
Parental single-dose therapy
(only in case of doubtful
compliance)
• Cephalosporins
(3rd generation)
• Gentamicin
Oral therapy to complete
10-14 days of treatment
Oral therapy to complete
5-7 days of treatment
EAU Guidelines 2006

62. Oral antimicrobials for pediatric UTI
Drug Dose (mg/kg/d) Frequency
CephalexinCephalexin 25-5025-50 q 6 hq 6 h
CefaclorCefaclor 2020 q 8 hq 8 h
CefiximeCefixime 88 q 12-24 hq 12-24 h
CefadroxilCefadroxil 3030 q 12-24 hq 12-24 h
NitrofurantoinNitrofurantoin 5-75-7 q 6 hq 6 h
AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h
AmoxicillinAmoxicillin 20-4020-40 q 8 hq 8 h
Pediatr Clin N Am 2006;53:379-400

63. Drug Dose (mg/kg/d) Frequency
CefazolinCefazolin 25-5025-50 q 6-8 hq 6-8 h
CefotaximeCefotaxime 50-18050-180 q 4-8 hq 4-8 h
CeftriaxoneCeftriaxone 50-7550-75 q 12-24 hq 12-24 h
CeftriazidimeCeftriazidime 90-15090-150 q 8-12 hq 8-12 h
CefepimeCefepime 100100 q 12 hq 12 h
AmpicillinAmpicillin 50-10050-100 q 6 hq 6 h
GentamicinGentamicin 7.57.5 q 8 hq 8 h
Parenteral antimicrobials for pediatric UTI
Pediatr Clin N Am 2006;53:379-400

64. Antibiotic prophylaxis for
Pediatric UTI
If there is an increased risk of UTI due to
congenital abnormalities, low dose
prophylaxis is recommended
Drug Daily dosage
(mg/kg/d)
Age limitation
CephalexinCephalexin 2-32-3 NoneNone
NitrofurantoinNitrofurantoin 1-21-2 >1 month>1 month
TMP-SMXTMP-SMX 1-21-2 >2 month>2 month
Pediatr Clin N Am 2006;53:379-400

65. Catheter Associated Urinary
Tract Infections (CAUTI)

66. Catheter Associated Urinary Tract
Infections (CAUTI)
 The most common nosocomial infection ( 40 %)
 Causes bacteremia in 2-4 % of patients
 Risk factors
 Increasing duration of use
 Female sex
 Absence of antibiotics
 Disconnection of catheter-collecting tube junction
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S

67. CAUTI – Pathogenesis
Two routes of entry-
• Periurethral
Common in females
Bacteria from rectal flora – Ecoli
• Intraluminal
Common in men
Pseudomonas, Proteus etc
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S

68. Intraluminal Route : Pathogenesis
BACTERIA
Attached to inner
surface of catheter
Growing within urine itself
BIOFILM Planktonic growth
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S

69. Biofilm Formation
Bacteria attached to inner
surface of catheter
Sheets of organisms coat cather
Secrete extracellular matrix of
bacterial glycocalyces
Tamm-Horsfall protein and urinary salts
are incorporated in biofilm growth
Encrustation of catheter & catheter
obstruction
Psudomonas are highly associated with propensity to form
biofilm.
American journal of medicine 1991; 16 (Suppl 3 B) : 65 S -70 S

70. BIOFILM FORMATION
PLANKTONIC BACTERIA
ATTACHMENT
MICROCOLONIES
BIOFILM COMMUNITY
Arch Intern Med / Vol.164,Apr 26,2004

71.  Decreased susceptibility to antibioticsDecreased susceptibility to antibiotics
• Physical impairment of diffusion of antibiotic agentPhysical impairment of diffusion of antibiotic agent
• Trapping of antibiotic within matrixTrapping of antibiotic within matrix
• Increased resistance rateIncreased resistance rate
 Misleading microbiological laboratory resultMisleading microbiological laboratory result
 Lacking of intrinsic defense systemLacking of intrinsic defense system
Clinical ImplicationClinical Implication
Arch Intern Med / Vol.164,Apr 26,2004

72.  The duration of catheterisation should be
minimal
 Prophylactic antibiotics and Chronic antibiotic
suppressive therapy is generally not
recommended
PreventionPrevention
EAU Guidelines 2010

73. Treatment for CAUTITreatment for CAUTI
• In case of symptomatic CAUTI, replace or remove the
catheter before starting antimicrobial therapy if the
indwelling catheter has been in place for > 7 days
• For empirical therapy, broad-spectrum antibiotics should
be given based on local susceptibility patterns
• After culture results are available, antibiotic therapy has
to be adjusted according to sensitivities of the pathogens
EAU Guidelines 2010

74. ProstatitisProstatitis

75.  Most common urological diagnosis in men < 50Most common urological diagnosis in men < 50
years and the third most common > 50 yearsyears and the third most common > 50 years
 10% of men have prostatitis like symptoms10% of men have prostatitis like symptoms
 Life time probability > 25%Life time probability > 25%
 Rates are similar in Asia, USA and EuropeRates are similar in Asia, USA and Europe
Prostatitis : How big is the problem?Prostatitis : How big is the problem?

76. Diagnosis: Quantitative segmental bacterialDiagnosis: Quantitative segmental bacterial
localization culture (Meares and Stamey)localization culture (Meares and Stamey)

77. NIH Classification of ProstatitisNIH Classification of Prostatitis
CasesCases
(%)(%)
Mid streamMid stream
Urine sepcimenUrine sepcimen
WBCWBC
CultureCulture
ProstaticProstatic
specimen (EPSspecimen (EPS
or VB3)or VB3)
WBCWBC
CultureCulture
ABP (I)ABP (I) < 1< 1 ++ +++ + ++ +++ +
CBP(II)CBP(II) 5-105-10 + ++ + + ++ +
CP/CPPS(III)CP/CPPS(III)
Inflammatory (IIIA)Inflammatory (IIIA)
NonNon
inflammatory(IIIB)inflammatory(IIIB)
80-9080-90
- -- -
- -- -
+ -+ -
- -- -
AIPAIP
(asymptomatic(asymptomatic
inflammatoryinflammatory
prostatitis)prostatitis)
1010 + -+ - - -- -

78. Which antibiotics?Which antibiotics?
Prerequisites for use of antibiotics for CBPPrerequisites for use of antibiotics for CBP
• Active against expected pathogens
• Effective penetration into the prostatic tissue
• Well tolerated – prolonged therapy (up to 12
weeks)
• Convenient to take

79. Pathogens causing CBPPathogens causing CBP
Generally acceptedGenerally accepted
 Escherichia coliEscherichia coli (50-80%)(50-80%)
 Klebsiella pneumoniaeKlebsiella pneumoniae
 Proteus miribalisProteus miribalis
 PseudomonasPseudomonas
aeruginosaaeruginosa
 Enterococcus faecalisEnterococcus faecalis
PotentialPotential
 StaphylococcusStaphylococcus
saprophyticussaprophyticus
 Staphylococcus aureusStaphylococcus aureus
 StaphylococcusStaphylococcus
epidermidisepidermidis
 StreptococcusStreptococcus
 Mycoplasma genitaliumMycoplasma genitalium
 Ureaplasma urealyticumUreaplasma urealyticum
 Chlamydia trachomatisChlamydia trachomatis
Campbells Urology, 9th
edition

80. TreatmentTreatment
Chronic Bacterial ProstatitisChronic Bacterial Prostatitis
• favourable pharmacokinetic properties
• excellent penetration in prostatic tissue
• antibacterial activity against gram negative
pathogens, including Pseudomonas aeruginosa as
well as gram positive pathogens
• good safety profile
EAU Guidelines 2010
Eur Urol Suppl 2007;6(2):72
Fluoroquinolones such as ciprofloxacin, levofloxacin
and prulifloxacin may be considered as drugs of choice
because of their:

81. Prulifloxacin 600 mg VsPrulifloxacin 600 mg Vs
Levofloxacin 500 mg in CBPLevofloxacin 500 mg in CBP
 At 2 weeks there was aAt 2 weeks there was a
greater reduction ingreater reduction in
symptom scoressymptom scores
 At 6 months 5 patients onAt 6 months 5 patients on
Prulifloxacin had a positivePrulifloxacin had a positive
Meares-Stamey test Vs 11Meares-Stamey test Vs 11
in the levofloxacin groupin the levofloxacin group
 Well toleratedWell tolerated
N =96, 4 weeks treatment
Prulifloxacin is as effective and safe as levofloxacin In the treatment
of CBP
With prulifloxacin there was trend to an earlier resolution of
symptoms.
Eur Urol Suppl 2007;6(2):72

82. Highlights
• UTI is the common infection occurring in young women
• The most common presentation in young non-pregnant
women is acute uncomplicated cystitis
• The recommended treatment for acute uncomplicated cystitis
Is short course with antimicrobials like:
- Fosfomycin
- Nitrofurantoin
- TMP/SMX
• The most common pathogen causing UTI is E.coli

83. Highlights
• Choice of antibiotics should take into account not only the
spectrum of activity but also resistance
• E.Coli has highest susceptibility and least resistance for
nitrofurantoin as compared to other commonly used
antimicrobials
• Nitrofurantoin has maintained its place in the management of
Uncomplicated cystitis due to highest susceptibility and least
resistance
• The newer formulation of nitrofurantoin (Nitrofurantoin
monohydrate/macrocrystals) offers the advantage of better GI
tolerability and BID dosing, which improves the compliance

84. Highlights
• One year prophylaxis with nitrofurantoin significantly
reduces the no of symptomatic episodes
• The antimicrobials used for prophylaxis are:
Fluoroquinolones, nitrofurantoin,TMP/SMX, cephalosporins
etc.
• Recurrent UTI can be managed by offerring long term
prophylaxis or post coital prophylaxis
• A major concern in the treatment of UTI is recurrence and
one in four women will develop recurrence

85. Highlights
• Fluroquinolones may be considered for empiric therapy of
complicated UTI due to their broad spectrum antibacterial
activity and good tissue penetration
• The treatment duration for the symptomatic UTI in pregnant
women should be 10-14 days
• Asymptomatic bacteriuria in pregnant women should be
treated
• The choice of antimicrobials in diabetic patients is similar
to non diabetics but the duration should be 10-14 days

86. THANK
YOU