urinary tract infection د. عبدالعظيم يوسف

Urinary tract infection ( UTI ) : Is sn infection that affects either the lower urinary tract which is called as bledder infection or cystitis or upper urinary tract infection which is called as kidney infection or pyelonephritis .. Sypmtomes of lower UTI : 1.pain above pubic bone or in the lower back . 2.frequent urination. 3.burning with urination . 4.feeling the need to urinate despite having an empty bladder ( due to irritation ) . Symptoms of upper UTI : 1.fever . 2.flank pain. 3.vomiting. 4.blood or pus in the urine ( rare ). 5.in addition to lower UTI symptoms .

-risk factors : 1.female gender because of : a.urethra is much shorter and closer to the anus . b.due to loss of the protective vaginal flora in menopause due to low estrogen levels . c.vaginal atrophy ( in menopause ) . 2.sexual intercourse . 3.diabetes mellitus . 4.obesity . 5.family history of recurrent UTI . -transmission : 1.blood born infection . 2.urinary catheterization .

-causes of UTI : 1.bacterial infections : a. Escerichia coli ( commonest cause ). b.Staphylococcus saprophyticus . c.Pseudomonas . d.Proteus mirabilis . e.Enterococcus . f.Klebsiella . g.Staphylococcus aureus . 2.viral & fungal infections ( rare ) .

Penicillins ( Amoxicillin ) : -side effects : -treatment : 1.antibiotics : A.cell wall inhibitors ( penicillins & cephalosporins ) . -mechanism of action : -B lactam antibiotics : they disrupt synthesis of peptidoglycan layer of bacterial cell wall , the bacteriocidal effect of drug result in lysis and death of the bacterial cell . -peptidoglycan is a strong structural molecule specific to the cell wall of bacteria . Penicillins ( Amoxicillin ) : -side effects : 1.allergic reaction , rash , itching . 2.fungal infection ( in mouth & vagina ) . 3.cramping, vomiting , diarrhea .

-precautions : 1.kidney disease . 2.pregnancy . 3.breast feeding woman due to passage of drug into breast milk . 4.viral infection like Infectious mononeucleosis . -drug interaction : 1.live bacterial vaccines . 2.methotrexate . It doesn’t interfere with hormonal birth control drugs . -Cephalosporins ( Cefixime ) . -side effects : 1.hypersensitivity ( rash , itching , hives ) . 2.difficulty in breathing , tithness in the chest . 3.yellowing the skin or eyes . 4.bloody stools .

-precautions : -drug interaction : 1.pregnancy . 2.breast feeding woman . 3.renal or hepatic failure . 4.patient with coagulation disorders ( low prothrombin activity ) . -drug interaction : 1.carbamazepine due to alteration in carbamazepine plasma concentration . 2.warfarine & oral anticoagulants due to delay in clotting time.

B.protein synthesis inhibitors : -mechanism of action : 1.bind 30 S Ribosomal subunit and interfere with initiation complex . 2.induce misreading of genetic code on messanger RNA . 3.break up of polysomes into monosomes . -e.g. Gentamicin . -side effects : 1.trouble breathing . 2.hypersensitivity reaction . 3.nephrotoxicity & ototoxicity . 4.muscle twitching & seizures .

-precautions : 1.patient with allergy . 2.cystic fibrosis . 3.hearing problems . 4.kidney problems . 5.Myesthenia gravis . 6.Parkinson”s disease . 7.breast feeding woman . -contraindications : 1.pregnancy . 2.patient with seizures . -drug interaction : 1.cephalosporins . 2.non steroidal anti-inflammatory drugs ( NSAID ) .

-Flouro quinolones & urinary antiseptics : -mechanism of action : 1.bind to A subunit of DNA gyrase enzyme . 2.prevent the binding of substrate of the active site of DNA gyrase . 3.absence of formation of enzyme substrate complex . 4.blockage of unwinding of double-stranded DNA into single-stranded structure . 5.prevention of synthesis of messanger RNA . 6.inhibition of bacterial protein synthesis . E.g. Ciprofloxacin . -side effects : 1. CNS problems , headache , light headedness .. 2.photo toxicity in exposure to heavy sun light . 3.connective tissue problems .

-precautions : -contra indications : 1.pregnancy & lactation . 2.children under 18 years of age . 3.photo –sensitivity . 4.patient with epilepsy . -contra indications : 1.cardiac arrhythmias . -drug interaction : 1.antacids . 2.theophylline . 3.warfarine , caffeine , cyclosporine .

-urinary antiseptics ( e.g. Nitrofurantoin ): -mechanism of action : Inhibit various enzymes & damage bacterial DNA . -side effects : 1.hemolytic anemia in patients with G6PD deficiency ( glucose 6 phosphate dehydrogenase ). 2.acute pneumonitis . 3.neurologic problems . 4.interstitial pulmonary fibrosis in chronic use of the drug . -contra indications : 1.anuria or oliguria . 2.renal failure . 3.pregnancy over 28 weeks .

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