012-3-11 Decision process for upper(pyelonephritis Prevention and lower(cystitis) urinary tract infections CYSTITIS PYELONEPHRITIS s The most important is for sexually active women to urinate shortly after sexual intercourse TREATMENT n Another useful suggestion is for patients with recurrent trimethoprim. UTIs to practice double or triple voiding Second line Fluoroquinolone Injectable cephalosporin s Increased fluid intake was previously advocate 5-7 days tal of w ulfonamides: there are no obvious benefits of excessive Pregnant women injectable cephalosporin for 5-7 days for 2 wk Prevention(cont Antimicrobial prophylaxis a Cranberry products have been pr a Prophylaxis is sometimes used in patients wit evention of recurrent UTIs. An of frequently recurring UTIs, esp. when there are no est that these products might have a low defined, treatable complications ventive effect in young and middle-aged women, but the use of cranberries is not recommended s In such patients, one daily dose of nitrofurantoin 100mg, taken at bedtime, is recommended mucosa and recurrent symptomatic UTIs, replacement herapy with oral or vaginal estriol should be catheterized patients because it results in the selection of micrbes resistant to the antimicrobial used considered ognosIs Prognosis(cont a The prognosis of uncomplicated cystitis and pyelonephritis is generally good unless urosepsis occurs om childhood pyelonephritis, chronic pyelonephritis er lead to a further ction of renal functio a Patients with urosepsis have a poor prognosis, with ■ calculi or the worsening of existing ones diseases, as well as inadequate antibiotic treatment. 102012-3-11 10 Decision process for upper(pyelonephritis) and lower(cystitis) urinary tract infections Prevention „ The most important is for sexually active women to urinate shortly after sexual intercourse. „ Another usefule suggestion is for patients with recurrent UTIs to practice double or triple voiding UTIs to practice double or triple voiding. „ Increased fluid intake was previously advocated, probably because of the risk of crystalluria with old￾sulfonamides; there are no obvious benefits of excessive diuresis. Prevention (cont.) „ Cranberry products have been proposed for the prevention of recurrent UTIs. Analyses of studies suggest that these products might have a low preventive effect in young and middle-aged women, but the use of cranberries is not recommended. but the use of cranberries is not recommended. „ In postmenopausal women with atrophic vaginal mucosa and recurrent symptomatic UTIs, replacement therapy with oral or vaginal estriol should be considered. Antimicrobial prophylaxis „ Prophylaxis is sometimes used in patients with frequently recurring UTIs, esp. when there are no defined, treatable complications. „ In such patients, one daily dose of nitrofurantoin 50- 100mg, taken at bedtime, is recommended. „ Antimicrobial prophylaxis should not be used in catheterized patients because it results in the selection of micrbes resistant to the antimicrobial used. Prognosis „ The prognosis of uncomplicated cystitis and pyelonephritis is generally good unless urosepsis occurs. Secondary morbidity is rare. „ Patients with urosepsis have a poor prognosis, with fatality rates of about 30% or higher. Factors increasing the risk of death are advanced age and underlying diseases, as well as inadequate antibiotic treatment. Prognosis(cont.) „ In patients with complications such as renal scars from childhood pyelonephritis, chronic pyelonephritis or glomerulonephritis, or other chronic renal diseases, acute pyelonephritis may lead to a further reduction of renal function. „ Infections with Proteus species or other ammonia￾producing organisms may lead to the formation of calculi or the worsening of existing ones