Urinary tract agents

Hooper DC. Urinary tract agents Nitrofurantoin and methenamine. In Mandell GL, Dolin R, and Bennet JE (Eds.). Mandell, Douglas, and Bennett s Principles and Practice of Infectious Diseases, 5th ed. New York Churchill Livingstone, 2000. 

Also includes antiproto2oan agents and other urinary tract antiinfectives, but does not include the antileprotic sulfones. 

L-Dopa and Trimethoprim are two other dmgs that can be made from vanillin. u-Dopa is used for the treatment of Parkinson s disease Trimethoprim is an antiinfective agent used mainly for urinary tract infections and certain venereal diseases. Also, Mebeverine, an antispasmodic agent, and Verazide, a generic antitubercular agent, are dmgs that can be made from vanillin or its derivatives. 

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

Carcinogens Cancer-producing agents Skin Respiratory Bladder/urinary tract Liver Nasal Bone marrow Coal tar pitch dust crude anthracene dust mineral oil mist arsenic. Asbestos polycyclic aromatic hydrocarbons nickel ore arsenic bis-(chloromethyl) ether mustard gas. p-naphthylamine benzidine 4-am i nodi pheny lam ine. Vinyl chloride monomer. Mustard gas nickel ore. Benzene. 

More then a dozen representatives of the above ring systems were introduced into the human therapy. Actisomide (2) and trequinsin (3) are used as antiarrhytmic and antihypertensive agents, respectively. Sunepitron (4), a a 2-adrenoceptor antagonist, is under clinical trials for the treatment of anxiety and depression. Representatives of the third generation of antibacterial quinolone-3-carboxylic acids the blockbluster ofloxacin (5), its levorotatory enantiomer, levofloxacin (6), and rufloxacin (7) have gained wide acceptance for the treatment of bacterial infections of the respiratory and urinary tracts, skin, and soft tissues, as well as sexually transmitted diseases, and pazufloxacin (8) is under development. Praziquantel (9) is widely applied for the treatment of schistosomes- and cestode-caused infection in both veterinary and human therapies (Scheme 4). 

In an unusual variant on the Chichibabin reaction, treatment of 3-hydroxypyridine with sodium amide at 200° affords 2,6-di-aminopyridine (21). Coupling of the product with benzenediazo-nium chloride gives phenazopyridine (22). This drug is used as an analgesic for the urinary tract in conjunction with antibacterial agents for treatment of urinary infections. 

Litholytic agents in current use are classified as direct or indirect. Indirect type drugs decrease the C.P. of urine, thus inhibiting calculus formation. An example is citrate which helps prevent insoluble salts from crystallizing in the urinary tract. Potassium citrate is administered in pill form as a preventive drug. Direct type drugs dissolve renal calculi which have already formed. 

Urinary tract Early ionic urographic agents including iodamide Uromiro Tubular secretion Difazio LT et al (1978) Pharmacokinetics of iodamide in normal subjects and in patients with renal impairment. J Clin Pharmacol 18 35-41... 

Over 10000 quinolone antibacterial agents have now been synthesized. Nalidixic acid is regarded as the progenitor of the new quinolones. It has been used for several years as a clinically important drug in the treatment of urinary tract infections. Since its clinical introduction, other 4-quinolone antibacterials have been synthesized, some of which show considerably greater antibacterial potency. Furthermore, this means that many types of bacteria not susceptible to nahdixic acid therapy m be sensihve to the newer derivahves. The most important development was the introduction of a fluorine substituent at C-6, which led to a considerable increase in potency and spectrum of activity compared with nalidixic add. These second-generation quinolones are known as fluoroquinolones, examples of which are ciprofloxacin and norfloxacin (Fig. 5.19). 

I TABLE 76-2. Commonly Used Antimicrobial Agents for the Treatment of Urinary Tract Infections... 

Ochratoxin A (OTA) is a my cotoxin produced by some species of Penicillium and Aspergillus. It is nephrotoxic to all animal species tested and the causal agent of mycotoxic porcine nephropathy (Krogh, 1978). It was previously associated with the human renal disorder, Balcan endemic nephropathy (BEN), and tumours of the urinary tract (Pfohl-Leszkowicz et al., 2002). Recently, another endemic kidney disease (Tunisian chronic interstitial nephropathy, CIN) was linked to OTA-contaminated food (Creppy, 1999 Wafa et al.,... 

The ability to eradicate bacteria from the urinary tract is directly related to the sensitivity of the organism and the achievable concentration of the antimicrobial agent in the urine. 

These agents generally have been replaced by more agents due to resistance. This combination is highly effective against most aerobic enteric bacteria except Pseudomonas aeruginosa. High urinary tract tissue levels and urine levels are achieved, which may be important in complicated infection treatment. Also effective as prophylaxis for recurrent infections,... 

This class of compounds comprises a series of synthetic agents patterned after nalidixic acid, a naphthyridine derivative introduced in 1963 for the treatment of urinary tract infections. Isosteric heterocyclic groupings in this category include the quinolones (e.g., norfloxacin, ciprofloxacin, lome-floxacin, gatifloxacin, sparfloxacin, moxifloxacin, and ofloxacin), the naph-thyridones (e.g., nalidixic acid, enoxacin, and trovafloxacin), and the cin-nolones (e.g., cinnoxacin) [2] (Fig. 1). 

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