Urinary tract infections, treatment

Thrombolytic agents a need for improvement Thyroid preparations Trace minerals essential for health Traveler s diarrhea prevention of Tuberculosis treatment of Upper respiratory tract infection treatment of Urinary tract infections treatment of Uveitis management of Vaginal candidiasis treatment of Vasodilators effects on cardiac output (CO)... 

Management of prune belly syndrome is primarily conservative (prevention of urinary tract infection, treatment of chronic renal failure when present). Surgical procedures are required only when obstruction is present. 

The sulfa dmgs are stiH important as antimicrobials, although they have been replaced in many systemic infections by the natural and semisynthetic antibiotics. They are of great value in third world countries where problems of storage and lack of medical personnel make appropriate use of antibiotics difficult. They are especially useful in urinary tract infections, particularly the combination of sulfamethoxazole with trimethoprim. Their effectiveness has been enhanced by co-adniinistration with dihydrofolate reductase inhibitors, and the combination of sulfamethoxazole with trimethoprim is of value in treatment of a number of specific microbial infections. The introduction of this combination (cotrimoxazole) in the late 1960s (1973 in the United States) resulted in increased use of sulfonamides. 

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. 

The sulfonamides are often used to control urinary tract infections caused by certain bacteria such as Escherichia coli, Staphylococcus aureus, and Klebsiella-Enterobacter. Mafenide (Sulfamylon) and silver sulfadiazine (Silvadene) are topical sulfonamides used in the treatment of second- and third-degree bums. Additional uses of the sulfonamides are given in the Summary Drug Table The Sulfonamides. 

Ms. Bartlett, age 80, has been prescribed a sulfonamide for a urinary tract infection and is to take the drug for 10 days. You note that Ms. Bartlett seems forgetful and at times confused. Determine what problems might be associated with Ms. Bartlett s mental state and her possible noncompliance to her prescribed treatment regimen. 

The natural and semi ynthetic penicillins are used in tire treatment of bacterial infections due to susceptible microorganisms. Fbnicillins may be used to treat infections such as urinary tract infections, septicemia, meningitis, intra-abdominal infection, gonorrhea, syphilis, pneumonia, and other respiratory infections. Examples of infectious microorganisms (bacteria) that may respond to penicillin therapy include gonococci, staphylococci,... 

The fluoroquinolones are used in the treatment of infections caused by susceptible microorganisms. The fluoroquinolones are effective in the treatment of infections caused by gram-positive and gram-negative microorganisms. They are primarily used in the treatment of susceptible microorganisms in lower respiratory infections, infections of the skin, urinary tract infections, and sexually transmitted diseases. Ciprofloxacin, norfloxacin, and ofloxacin are available in ophthalmic forms for infections in the eyes. 

From a clinical point of view, the sulphonamides are extremely useful for the treatment of uncomplicated urinary tract infection caused by E. coli in domiciliary practice. They have also been employed in treating meningococcal meningitis (a current... 

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... 

Johnson JR, Stamm WE. Urinary tract infection in women diagnosis and treatment. Ann Intern Med 1989 11 906-917. 

Binding affinities of the new flexible synthetic glycocluster toward type-1-piliated E. coli were evaluated by HAI and bladder-binding assay (BBA). The results indicated that, with an inhibition of bacterial bladder-cell binding at 12 nM ( 6000- and 64-fold lower than mannose and 59, respectively), the tetravalent compound 60 is currently one of the most promising antiadhesive drugs under development for the treatment of urinary tract infections. 

A 49 year-old woman is treated for an Escherichia ccli urinary tract infection (UTl). During treatment, the woman experiences hemolysis. 

The antibiotics that may be used for empiric treatment of sepsis are listed in Table 45-4. In the nonneutropenic patient with urinary tract infection, fluoroquinolones are generally recommended. 

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). 

Resistance to the drugs has developed over time current uses include treatment of gonorrhea, and upper and lower urinary tract infections in both sexes. 

Not indicated for definitive treatment but is compatible with drugs used to treat urinary tract infections. 

---