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Urinary Tract Infections, Pyelonephritis, and Prostatitis (TREATMENT…

- - - - Drugs used for UTI that have a minimal effect on fecal flora: pivmecillinam, fosfomycin, and nitrofurantoin.
      - In contrast, trimethoprim, TMP-SMX, quinolones, and ampicillin affect the fecal flora more significantly;
    - - first-line
        
        nitrofurantoin (Resistance remains low despite >60 yrs of use since it affects bacterial metabolism in multiple pathways)
        
        TMP-SMX (consider use in regions w/ resistance rates not exceeding 20%)
      - Second-line: fluoroquinolone
        
        Most are highly effective as short-course therapy for cystitis; the exception is moxifloxacin, which may not reach adequate urinary levels
        
        commonly used for UTI include ofloxacin, ciprofloxacin, and levofloxacin.
        
        a factor driving emergence of C. difficile outbreaks; in adults >60 yrs: a. w/ an increased risk of Achilles tendon rupture
      - Urinary analgesics are appropriate in certain situations to speed resolution of bladder discomfort.
- - - - independent for acute cystitis: frequent sexual intercourse, recent use of a diaphragm w/ spermicide, and a hx of UTI ;
      - independent for pyelonephritis in young healthy women: frequent sexual intercourse, a new sexual partner, a UTI in previous 12 months, a maternal Hx of UTI, diabetes, and incontinence
      - UTI in healthy postmenopause: sexual activity, diabetes mellitus, and incontinence
      - recurrent UTI in postmenopause: Hx of premenopausal UTI and anatomic factors affecting bladder emptying (cystoceles, urinary incontinence, and residual urine)
      - Women w/ diabetes : 2-3x higher rate of ASB and UTI than women w/o diabetes; there is insufficient evidence to make a corresponding statement about men; Poor bladder function, obstruction in urinary flow, and incomplete voiding are additional factors commonly found in patients w/ diabetes that increase the risk of UTI. Impaired cytokine secretion may contribute to ASB in diabetic women
- - - - severe: high fever, rigors, nausea, vomiting, and flank and/or loin pain.
      - Mild: low-grade fever w/ or w/o lower-back or CVA pain
    - - pxs w/ diabetes: sloughed papillae obstruct the ureter--> obstructive uropathy
      - also evident in some cases of pyelonephritis complicated by obstruction, sickle cell disease, analgesic nephropathy, or combinations of these conditions.