Urinary Tract Infections and Prostatitis

Infections of the urinary tract represent a wide variety of clinical syndromes, including urethritis, cystitis, prostatitis, and pyelonephritis. 

A urinary tract infection (UTI) is defined as the presence of microorganisms in the urine that cannot be accounted for by contamination. The organisms have the potential to invade the tissues of the urinary tract and adjacent structures. 

Lower tract infections include cystitis (bladder), urethritis (urethra), prostatitis (prostate gland), and epididymitis. Upper tract infections (such as pyelonephritis) involve the kidney and are referred to as pyelonephritis. Uncomplicated UTIs are not associated with structural or neurologic abnormalities that may interfere with the normal flow of urine or the voiding mechanism. Complicated UTIs are the result of a predisposing lesion of the urinary tract such as a congenital abnormality or distortion of the urinary tract, a stone, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses. 

Recurrent UTIs are characterized by multiple symptomatic episodes with asymptomatic periods occurring between these episodes. These infections are either due to reinfection or to relapse. 

Reinfections are caused by a different organism and account for the majority of recurrent UTIs. 

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Empirical Treatment of Urinary Tract Infections and Prostatitis ... 

See Chap. 120, Urinary Tract Infections and Prostatitis, authored by Elizabeth A. Coyle and Randall A Prince, for a more detailed discussion of this topic. 

Ciprofloxacin and ofloxacin have broader spectra of activity that includes some gram-positive organisms so they have been used for a broad range of infections. Oral ciprofloxacin or ofloxacin is indicated for the treatment of complicated urinary tract infections and prostatitis. Ofloxacin is an effective therapy for chlamydial urethritis/ cervicitis and acute pelvic inflammatory disease. Oral ciprofloxacin or ofloxacin is effective in the treatment of acute diarrhea caused by enterotoxic E. coli (e.g., travelers diarrhea). Salmonella, Shigella, and Campylobacter... 

Nalidixic acid and cinoxacin are useful only for treating urinary tract infections. Ciprofloxacin is useful for both urinary tract infections and prostatitis. 

The quinolones and fluoroquinolones may produce arthropathy, and hence should not be used in prepubertal children or pregnant women. Nalidixic acid and cinoxacin are useful only for treating urinary tract infections. Ciprofloxacin is useful for both urinary tract infections and prostatitis (see also Figure 85). 

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