Transcript Urinary Tract Ifection

Urinary Tract Infection
and Sexually Transmitted Diseases
Prof. R. K. Dixit
Pharmacology and Therapeutics
K.G.M.U. Lucknow
[email protected]
Urinary Tract Infection
Pyelonephritis
Upper UTI
Ureteritis
Vesico-ureteral Reflux
Lower UTI
Cystitis
Urethritis
•Upper Urinary tract (Kidney, Ureter)•Less common but More dangerous,
•Long term therapy
•Lower Urinary tract (Bladder, Urethra)•More common but Less dangerous
•Short term therapy
•Organisms•Mostly Gram Negative (E.coli, Klebsiella,
Proteus, Pseudomonas, Enterobacter,)
•Others- Staphylococcus, Viral, Fungal, …
• Single in acute, mixed in chronic
•Entry•Mostly from lower to upper (Ascending ),
•Some times
•Directly from the surrounding sites or
•From blood (bacterimia)
Symptoms
Symptoms-
(Severe Pain During UTI)
•Systemic symptoms- myalgia, vomiting, weakness etc.
•Pain (Pelvic, Rectal, lower abdomen or renal angle)
•Pungent smell of urine
•Dysuria (Burning),
•Denies urination (Fear of Urination)
•Discharge through urethra
•Discoloration of urine
•Urgency
•Temperature (Fever with chills)
•Incomplete emptying (Retention)
•Incontinence of urine
(Haematuria, Pyuria, Haziness, Clouding)
•More common in Females- Anatomical differences
•Other part involved •Prostate, Epididymis
•More common if•Stones
•Strictures
•Stents (Urinary Catheter)
•Structural abnormality
•Straight entry of ureter
•Sexually active
•Store urine (Faulty urinary habit)
•Surgical (abdomen)
•Scanty fluid intake
•Semiconscious (Unconscious),
•Site trauma,
Treatment of UTI
•Increased Fluid Intake and Voiding
•Analgesics, Antipyretics, Anti-inflammatory (NSAIDs)
•Alteration of pH
•Alkalizers – Potassium Citrate, Baking Soda,
•Beware of
•Dilution (1:10) of syrup (Gastric irritant)- 30 ml in 300ml
•Not with Nalidixic acid, Nitrofurantoin,
Methenamine
•Proteus which split urea and produce ammonia
and make urine alkaline.
Acidify with vitamin C, Mandelic acid (Syrup of
Ammonium Mandelate) and Cranberry (Karaunda)
•Urinary analgesics (Local)•Phenazopyridine (Symptomatic relief only, No
antibacterial property, Urine becomes orange red)
•Urinary antiseptics•Nitrofurantoin•Generates nitro-anion superoxide to damage
bacterial DNA,
•Dark brown urine,
•Peripheral neuritis, Intra-hepatic cholestasis
•Antagonism with Nalidixic acid
•Methenamine –
•Releases formaldehyde in acidic urine,
•Antagonism with sulfonamides
Antimicrobials------------------------(Q-BACTS)
•Quinolones -(Nalidixic acid, Norfloxacin……)
•Betalactams- Ampicillin/ Amoxicillin,
•Aminogycosides- Gentamicin, Amikacin, …
•Cephalosporins- Third generation
•Tetracyclines •Sulfonamides and Cotrimoxazole
•Other Antimicrobials•Chloramphenicol, Methicillin, Carbenicillin
etc……..
•Prophylaxis for UTI- Needed in
•Catherised,
•Uncorrectable anatomical abnormalities
•Inoperable prostate,
•Septicemia,
•Immuno-compromised,
•Trauma
•Note•In patients with impaired renal functions avoid
•Nitrofurnatoin, Nalidixic acid,
• Aminoglycosides,
•Potassium salt, and Acidifying agents
V
V
V
Sexually Transmitted Diseases (STD)
(Sexually Transmitted Infections (STI)
• Transmitted through sexual contacts
• Usual Presentations
–Genital ulcers
–Discharge (Urethral and vaginal)
–Abdominal Pain
–Swelling surrounding genital area
–Systemic symptoms (Fever, weakness etc. )
• Important STDs
–
–
–
–
Syphilis (Chancre (Hard sore, Painless)
Chancroid (Soft sore, Painful)
Gonorrhea
Non-gonococcal urethritis (Nonspecific)
• Chlamydia, Ureoplasma, Haemophillus, Mycoplasma
–
–
–
–
–
–
–
–
Herpes genitalis
AIDS (HIV)
Hepatitis B
Donovaniasis
Trichomoniasis
Wart (Genital Wart, Human Papilloma Virus strain 6 and 11)
Pubic Lice
Lymphogranuloma inguinalae
Chancroid
Clean
Herpes genitalis
HAND
Hepatitis B
AIDS (HIV)
With
Non-gonococcal urethritis
Soap
Donovaniasis
Wart (genital)
To
Syphilis
Loose
Trichomoniasis
Lymphogranuloma inguinalae
Germs
Lice
Gonorrhea
DISEASES DRUG OF CHOICE
1. Neisseria gonorrhoea
( gonococcus)
2. Syphillis
-Primary( chancre)
Early
Ceftriaxone 250 mg I.M/ Azithromycin/
Doxycycline
Amoxicillin/ Cefixime/Ciprofoxacin
(Single dose)
Procaine Penicillin-G 2.4 M.U. daily for 10
to 14 days or
Benzathine penicillin G 2.4 M.U Once
-Secondary (Condeloma Lata)
-Latent (< 1 yr)
- Latent (>1 yr)
or
-cardiovascular syphillis
-Tertiary
-Neurosyphillis
Benzathine penicillin G 2.4 M.U. weekly
for 3 weeks
or
Procaine Penicillin G 2.4 M.U. for 3 weeks
DISEASES
DRUG OF CHOICE
Herpes simplex
Acyclovir/ Valacyclovir
4.
(Non specific urethritis)
Lymphogranuloma venereum
Chalmydiae trachomatis
Doxycycline 100 mg BD for three weeks
or
Azithromycin 1 gm oral per week for
three weeks
5. Donovanosis
(Calymmatobacterium granulomatis)
Granuloma Inguinale
Azithromycin 1g per week for 3 weeks
or
Doxycycline 100mg BD for 3 weeks
3.
Chancroids
6.
(Haemophilus ducreyi)
Azithromycin 1g oral single dose
Or
Ceftriaxone 250 mg I.M sing dose
or
Erythromycin 500 mg QID for one week
7.Condyloma acuminatum
• Human Papilloma Virus strain 6 and 11
Treatment
Antiviral therapy: Interferon, Valaciclovir
Regional treatment : Podophyllotoxin
Laser, freezing (Cryosurgery)
Microwave
Big wart: excise by operation
Remember it ‘s different:
To Condyloma lata- Secondary Syphilis
8. Hepatitis
9.
B- Lamivudine
HIV- Zidovudine and other ART
STDs are Very BAD
• Valacyclovir (Acyclovir) - Herpes genitalis,
Genital Warts
• Betalactams
–Penicillins- Syphilis
–Ceftriaxone - Gonorrhea
• Azithromycin - Chancroid
• Doxycycline- Chlamydia, Donovanosis,
Gonorrhea