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Urinary tract infection antibiotics
7.1 Introduction
Urinary tract infection (urinary tract infection, urinary tract infection) is opening one of the most common infections physicians, hospitals and general practitioners in the use of antibiotics, account for a large proportion. The urinary tract is a continuous structural system, infection from the bladder to the kidney and surrounding tissue. Clinical manifestations vary widely, use of antibiotics should be based on clinical manifestations. Although urinary tract infection can occur in both sexes and all age groups, but healthy women for the most common and the typical symptoms of urinary tract infection Medical Education Network. Collecting Medical Education Network
Objective 7.2 Guide
This guide is used to treat urinary tract infection antibiotics, clinical pathways, is the systematic collection of literature developed in conjunction with local experience. In accordance with the guidelines treatment of urinary tract infection may be the best results, but the non-human for others. Therefore, a specific patient's treatment decisions, physicians must be competent according to the disease, test results and treatment of conditions for a decision.
7.3 pathogenesis and bacteriology
Urinary tract infection the most common way is to breed around the gut bacteria in the urethra, the urethra into the bladder, and then, bacteria from the bladder through the ureter to the kidney, leading to pyelonephritis. Blood-


borne infections can occur occasionally due to sepsis secondary to renal cortical gold aureus abscess.
Pathogens: E. coli; Staphylococcus saprophyticus; Department of intestinal bacteria: Klebsiella spp, Proteus, intestinal Bacteroides; Pseudomonas; genus Enterococcus;
In many communities, ampicillin resistance of E. coli is high (more results of the study group was 49.8% -62%) Medical Education Network
However, for trimethoprim - sulfamethoxazole, the first generation of cephalosporins 1,2, fluoroquinolones, amoxicillin - clavulanate potassium and gentamicin resistance were decreased. The recommendations in this guide is made based on these sensitive types.
7.4 urinary tract infection syndrome
The clinical urinary tract infection symptoms of many patients. According to affected area (on the urinary tract and lower urinary tract) and complications of the identification of syndromes (Table 7.1). Use of antibiotics according to gender.
Diagnosis of urinary tract infection 7.5 Medical Education Network
Urinary tract infection diagnosis was based on history, signs and laboratory tests to determine. Should be aware of risk factors, such as urinary tract stones, urinary and reproductive system equipment, surgical and congenital defects. Should ask the previous history of urinary tract infections, urinary tract abnormalities, sexual history, and other chronic diseases such as diabetes, kidney disease.
7.5.1 Urinalysis
Analysis and pyuria should be added bacterial culture sensitivity test. Such as nitrate test and esterase test positive, you can start antibiotic treatment.
7.5.2 urine culture
Based on the following number of bacteria. Make a diagnosis:
Cloning urine volume 103 units / ml, as cystitis.
Cloning urine volume 104 units / ml, as pyelonephritis.
Cloning urine volume 105 units / ml, asymptomatic urinary bacteria.
Use of antibiotics in general, should send urine culture, then culture results and adjust antibiotics.
Young women, no symptoms of bladder inflammation do not need to merge for urine culture. Before and after treatment the patients urine culture should be done are:7.5.3 Check the urinary tract
Recurrent cystitis and pyelonephritis in women with urinary tract infection patients and male patients should be IVP, ultrasound examination and culture for prostate massage fluid, if necessary, to do other tests.
7.6 Treatment of patients with non-consolidated levy
7.6.1 Asymptomatic Bacteriuria
A bacterial urinary asymptomatic patients is not recommended to use antibiotics, but the pregnant woman exception. (A, b)
Asymptomatic patients, but the number of bacteria in urine 105 clones units / ml, can be diagnosed with asymptomatic bacterial urine. People in each group can be the disease, but the elderly are most at risk. Treatment without benefit. Even if the elderly do not recommend treatment because the treatment does not reduce infection complications and mortality.
7.6.2 Female urinary tract infection
A female cystitis can choose the first and second generation cephalosporins nitrofurantoin. Trimethoprim - sulfamethoxazole, fluoroquinolones, and trimethoprim. (A, b)
B female cystitis using cephalosporins, nitrofurantoin, trimethoprim - sulfamethoxazole, courses of 7 days; or nalidixic acid treatment, treatment is also 7 days.
A female cystitis therapy with trimethoprim - sulfamethoxazole or fluoroquinolone therapy, recommended course of treatment for 3 days. (A, b)
A single treatment effect than the difference between multi-day therapy is not recommended for routine treatment of female bladder inflammation. (A, a)
Cystitis is a common disease of women, normal women reported 20% -40% incidence. Treatment options are: the first generation of cephalosporins 1,2, trimethoprim - sulfamethoxazole; nitrofurantoin, fluoroquinolones, trimethoprim; nalidixic acid. Fluoroquinolones generally are not as first-line treatment to reduce drug resistance. 7 day course of treatment is recommended, trimethoprim - sulfamethoxazole and fluoroquinolones exception.
Treatment of healthy women without symptoms of cystitis combined with trimethoprim - sulfamethoxazole (160/800mg) and fluoroquinolones (ciprofloxacin 250mg bid) 3 day course of treatment. Volume of a single treatment program is not so effective, no general recommendation.
Community for the first time cystitis patients do not need for urine culture before treatment. After treatment of asymptomatic women are not required for urine culture, only to relieve symptoms need to be urine culture. Invalid by a course of treatment for patients, urine culture in the waiting period should be replaced by another antibiotic. Most women do not have urinary bladder function and anatomical abnormalities, but the need for recurrent patients renal imaging studies to rule out urinary tract abnormalities. Of the recurrent patients, remission after the first treatment, you should consider preventive treatment for up to 6 months (Table 7.2).
Women of dysuria, urine culture after repeated for the negative, should be considered Chlamydia trachomatis, Neisseria gonorrhoeae, strains vaginitis or bacterial vaginosis hair and give appropriate treatment.
7.6.3 Women with recurrent urinary tract infection
B female recurrent urinary tract infection treatment is continued with a small dose of preventive treatment or preventive treatment after sexual intercourse, a period of 3 to 6 months. Effective drug is trimethoprim - sulfamethoxazole, nitrofurantoin, cefotaxime or trimethoprim. (B, a)
Recurrent urinary tract infection was due to relapse or reinfection. Recurrence was defined as the completion of antibiotic therapy within 2 weeks, persistent infection of the original pathogen; re-infection is of the former seizures, the symptoms disappeared 2 weeks after treatment, the infection by another pathogen. Recurrent episodes of 6 months or 1 year more than 2 times 3 times or more seizures, treatment options are:
the continued use of low-dose prophylactic antibiotics, 3-6 months.
If sexual intercourse is the incentive, the women should be preventive treatment after sexual intercourse.
When there are symptoms, intermittent treatment for their own
Repeated attacks on women in the prevention and treatment of urinary tract infection is taken every night or after sexual intercourse, trimethoprim - sulfamethoxazole (40/200mg), cephalexin (250 mg), nitrofurantoin (50 mg) or Trimethoprim (100 mg) (Table 7.2). Fluoroquinolones may be used as preventive medication, but should minimize the use, to prevent drug resistance.
Male urinary tract infection 7.7
Male urinary tract infection is most common in the elderly, prostate disease, urethral obstruction and urinary tract equipment checks. Must be made before and after treatment urine culture to determine the bacterial sensitivity and confirm cure. In addition, a comprehensive examination must be excluded prone factors. The most common urinary tract infection syndrome, acute prostatitis, chronic bacterial prostatitis and chronic aseptic prostatitis. Despite the high incidence of community, but the lack of control group. Guide to the or opinions of experts from the relevant clinical experience.
Acute prostatitis
Recommended treatment of acute prostatitis B drug trimethoprim - sulfamethoxazole, fluoroquinolones, 4 weeks. (B, )
Acute prostatitis fever, difficulty urinating. Pain in lower back and perineum. Positive urine culture, blood cultures are often positive. Taboo of prostate massage. If you can not eat or vomiting should be hospitalized and intravenous antibiotics. Inflammation of the gland, all the antibiotics can penetrate into the gland, it can be like the treatment of women with pyelonephritis, as treatment with cefotaxime or gentamicin. If there is no systemic symptoms or the symptoms improved after treatment, can be oral antibiotics such as trimethoprim - sulfamethoxazole use of antibiotics to penetrate into the prostate, treatment for 4 weeks. Repeatedly made necessary by the treatment of chronic prostatitis.
Chronic bacterial prostatitis
B recommended treatment of chronic bacterial prostatitis drug trimethoprim - sulfamethoxazole, fluoroquinolones, for 12 weeks. (B, )
Chronic bacterial prostatitis is diagnosed by prostate fluid cultures. Should be used in fat-soluble and can penetrate into the prostate of antibiotic treatment (Table 7.2). Such as trimethoprim - sulfamethoxazole (160/800mg)
Or a fluoroquinolone (ciprofloxacin 500mg) 1 to 2 times for 12 weeks, with symptoms of prostate calcification or obstruction, the need for surgery.
Some patients need long-term suppressive therapy, take up to 6 months or more.
Chronic aseptic prostatitis
C chronic aseptic prostatitis is the choice of doxycycline or erythromycin. (C, )
Chronic aseptic prostatitis is the most common type of prostate infection. Leukocytes in prostatic fluid, but culture negative. Chlamydia should be considered, the original body is urea or Mycoplasma infection. Substances listed in Table 7.2 can be given a course of empirical therapy may be better to ease symptoms, and often need to use other drugs, should be recommended to the urology clinic.
No prostate symptoms or urinary tract abnormalities in the urinary tract infection
A small number of male urinary tract infections, prostate symptom-free, no urinary tract abnormalities, cystitis can be treated in accordance with, the choice of antibiotics in Table 7.2, treatment of 1-2 weeks.
7.6.5 Women pyelonephritis
B women with acute pyelonephritis the initial treatment is with intravenous amphotericin 1,2 generation cephalosporin plus aminoglycoside hospitalization; or with a -lactamase inhibitors lactams or fluoroquinolones are also effective ; mild patients can use oral first generation of cephalosporins 1,2, containing -lactamase inhibitors lactam. If the urine culture results, antibiotics can be adjusted in turn, the course of 14 days. (B, )
Performance of women with acute pyelonephritis, cystitis-like symptoms, but the pain was; seriously ill patients with fever, chills, nausea, vomiting, abdominal pain or severe sepsis. Patients with mild or no vomiting in the outpatient oral antibiotics. Seriously ill patients should be hospitalized, infusion, and to parenteral antibiotics.
Despite the high incidence of the disease, but the efficacy of various antibiotics, the absence of randomized controlled trials, the most common pathogenic bacteria, E. coli to common antibiotics (eg amoxycillin) resistance to more and more resistance of different communities also different, so hard to make certain of the overall treatment of patients. The choice of antibiotics should be based on pathogens in the region's sensitivity to various antibiotics, depending on the report or on non-randomized clinical use.
Choice of intravenous antibiotics, the first generation of cephalosporins plus aminoglycosides 1,2; 3rd generation cephalosporins, -lactamase inhibitor or a fluoroquinolone drugs (Table 7.3). Recommended the use of antibiotics before the urine culture and antibiotic adjusted based on the results. Recommended course of 14 days.
7.6.6 Urinary Tract Infection Pregnancy
A pregnant women with asymptomatic bacterial culture and sensitivity of urine application of test results based on use of antibiotics to reduce the symptoms of pyelonephritis and other mergers. (A, a)
B pregnant women experience acute cystitis recommended treatment is the first generation of cephalosporins 1,2, nitrofurantoin, trimethoprim - sulfamethoxazole (after 3 months of pregnancy with caution.) According to the adjusted bacterial culture and antibiotic sensitivity tests, treatment for 7 days. (B, )
B recommended pregnant women experience in the treatment of pyelonephritis is the 3rd generation cephalosporins. According to adjust the bacterial culture and antibiotic sensitivity tests, the course of 14 days. (B, )
As the role of pregnancy hormones that urinary tract dilatation, trimethoprim - sulfamethoxazole oppression pregnant uterus relative obstruction to renal pelvis, prone to bacterial urine. Bacteria in the urine of pregnant women are asymptomatic high-risk populations, it is the development of symptomatic urinary tract infection, pyelonephritis and premature delivery. Should be routine for pregnant women with asymptomatic bacterial urine screening and treatment based on bacterial culture. Of symptomatic urinary tract infection should be actively treated with antibiotics.
The choice of antibiotics should be based on severity and safety of the fetus. In general, penicillin, cefotaxime, and nitrofurantoin are safe; quinolones should be avoided; Similarly, there aminoglycoside ototoxicity; sulfa drugs late in pregnancy can lead to neonatal kernicterus syndrome, and finally, within the - lactamase inhibitor, Imipenem and single ring lactam antibiotics on the safety of pregnancy, not yet conclusive, should be used with caution.
The treatment of asymptomatic bacteria in urine urine culture should be based on use of antibiotics, the choice of nitrofurantoin, amoxicillin, trimethoprim - sulfamethoxazole, taking 3 days. Treatment before making a urine culture, if still positive, then for 7 days. Close follow-up urine culture, appropriate treatment and prevention, the pregnant women with pyelonephritis, cystitis can be avoided.
Acute cystitis when waiting for the results of urine culture, with the first generation of cephalosporins 1,2, nitrofurantoin or trimethoprim - sulfamethoxazole treatment. Pyelonephritis pregnant women intravenous application of 3rd generation cephalosporins therapy (Table 7.3), this is the safest option; someone using amoxicillin, trimethoprim - sulfamethoxazole plus gentamicin treatment of pregnant women pyelonephritis, but the ototoxicity of gentamicin on the fetus.
Before and after treatment in the treatment of urine culture should be done, based on the results to adjust antibiotics. 7 days treatment of acute cystitis, pyelonephritis, 14 days. Of recurrent patients with asymptomatic bacteria in the urine and / or symptomatic urinary tract infections, the need for preventive treatment during the entire pregnancy
7.7 urinary tract infections with complications
C with symptoms of urinary tract infection merger should be based on selection of bacterial culture and antibiotic susceptibility testing, empirical treatment can be used after the onset of symptoms, but antibiotics should be based on urine samples taken for bacterial culture, based on the results to adjust medication. (C, )
A mild or moderate symptoms of urinary tract infection combined patients, recommended oral fluoroquinolones, trimethoprim - sulfamethoxazole. (A, b)
C mild or moderate symptoms of urinary tract infection combined patients another treatment program is the first generation of cephalosporins, or with 1,2- -lactamase inhibitors lactam antibiotics. (C, )
C patients with underlying diseases or suffering from a complication of urinary tract infection, recommended intravenous 3rd generation cephalosporins, fluoroquinolones, or with a -lactamase inhibitors lactam antibiotics; the other is to use intravenous therapy ampicillin plus gentamicin is also effective. (C, )
Because the underlying cause of many diseases and complications in type, there are complications for the treatment of urinary tract infections, mainly based on the sensitivity of bacterial communities. The following 3 groups focused on complications, structural abnormalities, urethral catheter and renal dysfunction.
Usually the treatment of this group of patients the use of antibiotics and similar patients without complications. However, cure rate in this group, the recurrence rate is high. Prolonged use lead to drug resistance. Therefore, to avoid the experience of drug use, should be based on the results of bacterial culture and sensitivity test use of antibiotics.
After the onset of symptoms can be treated with the experience, but must be taken with antibiotics before urine culture, after adjustment based on the results of antibiotics. Use of antibiotics according to the condition and renal function. Mild to moderate patients, the randomized controlled study, oral administration of fluoroquinolones and trimethoprim - sulfamethoxazole has the same effect (Table 7.4). 1,2 Clinically, the common generation of cephalosporins, or with a -lactamase inhibitors lactam antibiotics.
Urinary tract infection have combined patients and more severe patients, recommended intravenous drugs, the third generation cephalosporins, fluoroquinolones, or with a -lactamase inhibitors lactam antibiotics. Another treatment is the ampicillin plus aminoglycoside is also effective, because at this time often Enterococcus or Pseudomonas aeruginosa. South ammonia song carbapenem (imipenem or meropenem) should be reserved for the initial treatment fails or resistant patients.
Empirical treatment started after the culture results should be adjusted according to antibiotics. Generally recommended treatment for 14 days.
7.7.1 structural abnormalities
With structural abnormalities (stones, urinary tract obstruction or obstruction) of the patients is often accompanied by production of urease of Proteus mirabilis. Experience with treatment, adjusted according to culture results of antibiotics, treatment at least 14 days. Some patients need 4 weeks, and needs long-term suppressive therapy to prevent kidney stones increase the real damage.
7.7.2 catheter associated urinary tract infections
Catheter bacterial growth rate of 5% per day, symptoms of urinary tract infections is not recommended to use antibiotics. Urethral catheter for short-term patients, such as the occurrence of symptomatic urinary tract infection, should try to pull out the catheter, and antibiotic treatment given 7 days to prevent drug resistance. Urethral catheter for long-term patients, after the onset of symptoms, but also to the 7 days treatment.
7.7.3 Renal failure patients urinary tract infection
Patients with renal dysfunction, need to learn to use effective antibiotics in the urine to achieve effective blood concentration, and degree of renal function according to dose adjustment. Nitrofurantoin and the aminoglycosides is not valid for such patients, in the urine can not achieve an effective concentration. Moreover, the aminoglycoside renal toxicity, renal function requires strict accordance with the adjustment of the dose of such patients to avoid drug use as a regular experience. If after 14 days of treatment after relapse, a longer course of treatment application, up to 6 weeks to cure.
7.8 Treatment of evaluation indicators
Recommended empirical treatment is based on projections of possible pathogens in the clinical use of antibiotics, while the strong, broad spectrum antibacterial antibiotics reserved for severe cases. First-line antibiotic treatment fails, the antibiotic resistant bacteria. Monitoring the situation first-and efficacy of other antibiotics, will be able to reguidelines and found that antibiotic resistance, and to facilitate future revisions of the guidelines.
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