Pharmacotherapy of __Urinary Tract Infections______
Stefanie Martin, PharmD Candidate 2007
Epidemiology Varies with age and sex.
Disease State
Definition
Pathophysiology
Clinical
Presentation
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Newborns < 6mo – prevalence 1% (mostly males)
Age 1-5 – female prevalence 4.5%, male prevalence 0.5%
Preschool age – males
Grade school – puberty – prevalence 1%
After puberty – prevalence 4% in females
25% of women – lifetime prevalence (men < 0.1%)
Elderly – equal
Presence of microorganisms in the urinary tract that cannot be accounted for by contamination.
This infection may be just the presence of bacteria without symptoms of an infection, or can be
accompanied by symptoms of infection.
 Cystitis or lower urinary tract infection involve the bladder.
 Urethritis involves infection of the urethra.
 Prostatitis involves the infection of the prostate.
 Pyelonephritis is an infection of the kidney and is also called an upper urinary tract infection.
Urinary tract infections can also be classified as being complicated and uncomplicated.
 Uncomplicated urinary tract infections involve individuals who do not have
functional/structural abnormalities of the urinary tract (generally women aged 15-45 years
old).
 Complicated UTIs evolve from a lesion in the urinary tract (abnormality, catheter, stone, BPH,
etc.) and men
Uncomplicated UTI:
 Bacteria typically arise from normal bowel flora.
 85% of uncomplicated UTIs are caused by e. coli.
 5-15% - staphylococcus saphrophyticus
 Klebsiella pneumoniae
 Proteus Spp.
 Pseudomonas aeruginosa
 Enterococcus spp.
Complicated UTI:
 E. coli < 50%
 Proteus spp.
 K. pneumoniae
 Enterobacter spp
 P. aeruginosa (25%)
 Staphylococci
 Enterococci – 2nd most common in hospitalized patients (25%)
 Vancomycin resistant E. faecalis and S. Faecium
 Candidia – common in critically ill, underlying malignancies, and long-term hospitalization.
Route of Infection:
1. Ascending – most common involving women. Bacteria infect urinary tract from fecal flora.
2. Hematogenous (descending) – dissemination of organisms from a distant infection in the body.
Uncommon
3. Lymphatic – little evidence to support this theory.
Signs and Symptoms:
 Lower UTI: dysuria, urgency, frequency, suprapubic heaviness, gross hematuria
 Upper UTI: flank pain, fever, nausea, vomiting, malaise, CVA tenderness
Labs:
 Bacteriuria
Student Name, PharmD Candidate 2007
University of Maryland School of Pharmacy
Pharmacotherapy Presentation – Pharmaceutical Care Rotation
Happy Harry’s Pharmacy Patient Care Center, Perryville, MD
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Pyuria (WBC < 10/mm3)
Nitrate positive urine
Leukocyte esterase- positive urine
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Obstruction (BPH, urethrial stricture, stones, tumors, etc) – disrupts the natural flow of urine
that flushes bacteria from the urethra
Vesicoureteral reflex – condition in which urine is forced up into the ureters to the kidneys;
results from a congenital abnormality or bladder overdistention
Urinary catheterization
Medical instrumentation
Pregnancy
Use of spermicides and diaphragms
Diagnosis
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Patient History (signs and symptoms) – unreliable for the diagnosis of UTI alone
Isolation of a significant number of bacteria from the urine (microscopic examination)
Urine culture
Dipstick urinalysis for leukocyte esterase
Dipstick test for nitrate
Pyuria (WBC > 10/mm3)
Desired
Therapeutic
Outcomes*
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Prevent and treat systemic consequences of infection
Eradicate the living organism
Prevent recurrence of infection
Risk Factors
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*Reference of
Guidelines Used
Treatment
Options**
* DiPiro Pharmacotherapy
** see treatment options table
(Non-drug and
Drug Therapy
– include all
therapeutic
classes/agents
available and
preferences
per treatment
guidelines)
**See Treatment
Options Table
Student Name, PharmD Candidate 2007
University of Maryland School of Pharmacy
Pharmacotherapy Presentation – Pharmaceutical Care Rotation
Happy Harry’s Pharmacy Patient Care Center, Perryville, MD
Monitoring
Efficacy: signs and symptoms of infection, urine culture and sensitivity
(Efficacy and
Toxicity
Parameters)
Toxicity: ** See treatment options table
Student Name, PharmD Candidate 2007
University of Maryland School of Pharmacy
Pharmacotherapy Presentation – Pharmaceutical Care Rotation
Happy Harry’s Pharmacy Patient Care Center, Perryville, MD