Antimicrobial therapy urinary tract infections

May be effective in the treatment of acute urinary tract infections caused by susceptible strains of gram-positive and gram-negative bacteria, especially Enterobacter sp. and Escherichia coii. It usually is less effective than other antimicrobial agents in the treatment of urinary tract infections caused by bacteria other than mycobacteria. Consider using only when the more conventional therapy has failed and when the organism has demonstrated sensitivity. 

For infections frequently encountered outside hospitals, e.g. uncomplicated urinary tract infection in young women, surveillance of resistance data of the most likely pathogens Escherichia coli) allows physicians to prescribe empiric therapy without performing cultures in the individual patient. However, in severely ill hospitalised patients, it is necessary to take samples for culture before starting empiric therapy. Microscopy of the Gram stained smear can help fine-tune empiric therapy at an early stage. Whether the infection is community-acquired or hospital-acquired, and whether the patient has been exposed to previous antimicrobial therapy should also be taken into account when choosing empiric therapy. 

Hoigne R, Klein U, Muller U. Results of four-week course of therapy of urinary tract infections a comparative study using trimethoprim with sulfamethoxazole (Bactrim Roche) and trimethoprim alone In Hejzlar M, Semonsky M, Masak S, editors. Advances in Antimicrobial and Antineoplastic Chemotherapy. Munchen-Berhu-Wien Urban and Schwatzenberg, 1972 1283. 

AIDS." A primary infection that is treated with the combination is PCP. The sulfonamide-trimethoprim combination can be used fur treatment and prophylaxis. Additionally, cerebral toxoplasmosis con be treated in active infection or prophyluctically. Urinary tract infections and bum therapy" " " round out the list of therapeutic applications. The sulfonamides arc drugs of choice for a few other types of infections, but their u.sc is quite limited in modem antimicrobial chemotherapy." " "... 

The proper route of administration for an antimicrobial depends on the site of infection. Parenteral therapy is warranted when patients are being treated for febrile neutropenia or deep-seated infections such as meningitis, endocarditis, and osteomyelitis. Severe pneumonia often is treated initially with intravenous antibiotics and switched to oral therapy as clinical improvement is evident. Patients treated in the ambulatory setting for upper respiratory tract infections (e.g., pharyngitis, bronchitis, sinusitis, and otitis media), lower respiratory tract infections, skin and soft tissue infections, uncomplicated urinary tract infections, and selected sexually transmitted diseases may receive oral therapy. 

Chronic bacterial prostatitis occurs when acute bacterial prostatitis has been inadequately treated because of pathogen resistance, relapse, or short-course therapy or because of blocked drainage of secretions from the prostate. Most men with chronic prostatitis will have had a previous bout of acute prostatitis. The most common clinical feature of chronic prostatitis is recurrent urinary tract infections and the symptoms and complaints of acute bacterial prostatitis. Fluoroquinolones, trimethoprim-sulfamethoxazole, doxycycline, and nitrofurantoin are used in the management of chronic prostatitis. Chronic prostatitis warrants at least 10 to 12 weeks of therapy. Poor clinical outcomes, however, have been observed because of poor diffusion of antimicrobials into the prostate. 

Reviews - The experimental aspects of the chemotherapy of tuberculosis were reviewed by Batten, clinical aspects were discussed editorially. Browne reviewed the treatment of leprosy. A favorable editorial comment was made on the use of an antimutagen (quinacrlne) with standard treatment of urinary tract Infection to prevent the rise of resistant bacterial strains. Lampe examined the changing concepts in the therapy of urinary tract disease. The not unrelated fields of sulfonamides, and nitro-furans were also reviewed. The resistance development as a consequence of antimicrobial drugs in animal feeds was examined. Topical antimicrobials were reviewed in several contexts antiseptics and disinfectants, soap bacteriostats,deodorants and antlperspirants,and antimicrobial biguanides. The topical treatment of burns and the renaissance of mafenide for such use was discussed by Moncrief. Veterinary ophthalmic antimicrobials were reviewed. 

This may be found by routine urine testing of pregnant women or patients with known structural abnormalities of the urinary tract. Such infection may explain micturition frequency or incontinence in the elderly. Appropriate antimicrobial therapy should be given, chosen on the basis of susceptibility tests, and normally for 7-10 days. Amoxicillin or a cephalosporin is preferred in pregnancy, although nitrofurantoin may be used if imminent delivery is not likely (see below). 

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