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Background
A urinary tract infection (UTI) is a bacterial infection that affects the bladder and its surrounding components. Without symptoms, bacteriuria does not constitute a UTI. Urinary urgency, frequency, dysuria, and suprapubic pain are common symptoms.
Many UTIs resolve independently; however, many patients seek treatment for symptomatic relief. The treatment aims to prevent the disease from progressing to the kidneys or developing into upper tract infection or pyelonephritis, which can damage the delicate nephron structures and result in hypertension.
Epidemiology
Urinary tract infections are among the most common bacterial infections in women. Females are more likely than males to get urinary tract infections with a ratio of 4:1.
UTIs affect 40% of women in the United States, making them one of the most prevalent infections in women. UTIs in circumcised males are infrequent; by definition, every male UTI is considered complex.
Over 60% of women acquire infection at least once in their lifetime, with a yearly infection rate of 10%. Recurrences are frequent, with approximately half of the infected women developing another infection within the same year.
Anatomy
Pathophysiology
The bladder mucosal membrane is infiltrated by bacteria, which causes cystitis, an inflammatory response. Enteric coliforms, which commonly live in the periurethral vaginal introitus, are the leading cause of UTIs. These bacteria infiltrate the bladder through the urethra and cause UTIs.
Sexual intercourse promotes the spread of bacteria into the bladder. Bacteria responsible for UTIs contain adhesins on their surface that enable them to adhere to the urothelial mucosal membrane.
Furthermore, a small urethra facilitates uropathogenic infiltration of the urinary system. Premenopausal women have high lactobacilli concentrations in the vagina and an acidic pH, which prevents uropathogenic colonization. Antibiotics, on the other hand, can nullify this protective effect.
Etiology
The most common bacteria associated with UTIs are Escherichia coli and Klebsiella. Women are more likely to have urinary tract infections because pathogenic bacteria ascend from the rectum and perineum. Additionally, women’s urethras are shorter than men’s, which increases their vulnerability to UTIs.
Blood-borne bacteria cause some uncomplicated UTIs. UTIs are relatively frequent following a kidney transplant. The use of immunosuppressive medications and vesicoureteral reflux are the two triggers. UTIs can also be caused by sexual activity, diaphragms, and spermicides.
Other risk factors include:
Genetics
Prognostic Factors
Most UTI symptoms can continue for several days, even with effective antibiotic therapy. The quality of life could be poor in women who experience recurring UTIs.
These recurrences occur in about 25% of women within six months. Despite the low mortality rates, UTIs are highly morbid. In addition to the unpleasant symptoms, management is prohibitively expensive.
Common residual effects include missing work and school; occasionally, hospitalization is necessary due to the intensity of the symptoms.
Factors that contribute to poor prognosis:
Clinical History
Physical Examination
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Differential Diagnoses
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
by Stage
by Modality
Chemotherapy
Radiation Therapy
Surgical Interventions
Hormone Therapy
Immunotherapy
Hyperthermia
Photodynamic Therapy
Stem Cell Transplant
Targeted Therapy
Palliative Care
Medication
20 - 40
mg/kg
Tablet
daily in 3 to 4 divided doses
imipenem/cilastatin/relebactam
1.25
g
Solution
Injection
every 6 hours
4 - 14
days
Uncomplicted:250mg intravenous every 6 hours
Complicated:500mg intravenous every 6 hours
Dose Adjustments
Renal impairment
CrCl<5 ml/min/1.73m2: Only use IV if hemodialysis will start within 48 hours
CrCl≤20 ml/min/1.73m2 :125-250mg IV every 12 hours
CrCl 21-40 ml/min/1.73m2: 125-250mg IV every 12 hours
CrCl 41-70 ml/min/1.73m2: 250mg IV every 8 hours
CrCl≥71 ml/min/1.73m2: 250mg IV every 6 hours
Indicated for chronic urinary tract infections:
Initial dose:12mg/kg/day orally divided every 6-8 hours on an empty stomach
Maintenance dose:250mg orally every 6-8 hours. Do not exceed 1.5g/day
Dose Adjustments
Renal impairment
The serum creatinine (SCr) levels in the blood determine the recommended frequency and amount of the medication to be taken. If the SCr level is between 1.8-2.5 mg/dL, the medication should be taken every 12 hours, with a maximum daily dose not exceeding 1 g. However, if the SCr level is more significant than 2.5 mg/dL, the medication is not recommended
500mg-1g intramuscular or intravenous every 8 to 12 hours. Do not exceed 8g/day
Indicated for Urinary Tract Infection Without Complications:
1
g
powder for injection
Intravenous (IV)
every 12 hrs
250 to 500 mg of ciprofloxacin in case of mild to moderate UTI
It must be administered orally every 12 hours for 7 to 14 days
400 mg of norfloxacin should be given twice daily to females for 3 days and to males for 5 days
400 mg of norfloxacin should be given twice daily to females for 3 days and to males for 5 days
methenamine/sodium salicylate/benzoic acid
Indicated for the prevention of UTI
2 tablets orally every 12 hours
Use this medication only after the UTI has been eradicated through any other appropriate antibiotic
methenamine is indicated for suppression or prophylaxis for chronic recurring urinary infections when long-term therapy is required
sodium salicylate is used as an analgesic
benzoic acid evokes weak antibacterial and antifungal properties
It helps to acidify the urine
methenamine/sodium acid phosphate
Indicated for Urinary Tract Infection as Prophylaxis
Initial dose: two tablets orally four times a day with fliud
Maintenance dose: one-two tablets orally two times a day
It should only be administered after the eradication of a urinary tract infection using other antibiotics
macrocrystals: Administering an oral dose of 50-100 mg every 6 hours is recommended for seven days or until three days after obtaining a urine sample free from contamination
monohydrate/macrocrystals: Administering 100 mg orally every 12 hours for seven days or until three days after obtaining a sterile urine sample
Long-term suppression/prophylaxis: Administering 50-100 mg of macrocrystals orally at bedtime for a maximum duration of 12 months
Indicated for prophylaxis of urinary tract infection
1 capsule/tablet orally every 6 hours sufficiently with fluids
Use only after the complete removal of urinary infection by any other antibiotics
methenamine is indicated for suppression or prophylaxis of chronic recurrent urinary infections when there is a requirement for long-term therapy
hyoscyamine is indicated for augmented therapy of the lower urinary tract spasm and hypermotility
methenamine/methylene blue/ hyoscyamine/ sodium phosphate monobasic/ phenyl salicylate
Irritative Voiding Symptoms:
Symptoms of UTI or diagnostic procedures: one tablet/capsule orally every 4 times a day with plenty of fluids
Take a dose of 375 to 750 mg orally two times a day for 5 to 14 days
382 to 764mg given orally every 4 times a day
Dose Adjustments
Dosage modifications
Renal impairment
382 to 764mg given orally every 1-2 times a day
Administer dose of 500 mg intramuscularly or intravenously every 8 hours
Administer dose of 0.5 to 2 g daily intramuscularly or intravenously in 1 or 2 daily doses
408 mg twice a day is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base). If necessary, the dose may be increased to 1,224-1,632 mg over 24 hours for severe infections
Administer 3 to 4 mg/kg/day in two divided doses every 2 times a day
Dose Adjustments
Dose modifications
Renal impairment
CrCl 20-40 mL/min: 4 to 6.5 mg/kg administered once a day or in divided dosages everyday
CrCl 40-60 mL/min: 4 to 6 mg/kg administered once a day or in divided dosages every 2 times a day
Liver impairment
dose adjustment is not required
250 mg orally 4 times daily or 500 mg twice daily in infections where other antibiotics are not effective
In the case of resistant infections, increase the dose to 500 mg 4 times daily or 1 gm twice daily
For children > 40kg only::
20 - 40
mg/kg
Tablet
Orally
daily in 3 to 4 divided doses
Indicated for chronic urinary tract infections:
Initial dose:10mg/kg/day orally divided every 6-8 hours on an empty stomach
methenamine/sodium salicylate/benzoic acid
Used for prevention of UTI
Not indicated for children below 16 years
For children more than 16 years- 2 tablets orally every 6 hours
Use this medication only after the UTI has been eradicated through any other appropriate antibiotic
methenamine is indicated for suppression or prophylaxis for chronic recurring urinary infections when long-term therapy is required
sodium salicylate is used as an analgesic
benzoic acid evokes weak antibacterial and antifungal properties
It helps to acidify the urine
Age>1 month
Administer orally divided every 6 hours for seven days at a dosage of 5-7 mg/kg/day
Prophylaxis of UTI: Administering a dosage of 1-2 mg/kg orally once daily at bedtime or in two equally divided doses
Age>12 years
macrocrystals: Administering an oral dosage of 50-100 mg every 6 hours is recommended seven days or for three days following the attainment of a urine sample free from any contaminants
macrocrystals/monohydrate: Administering a dosage of 100 mg orally every 12 hours is recommended either seven days or for three days following the attainment of a urine sample free from any contaminants
Long-term suppression /prophylaxis: Take 50-100 mg of macrocrystals orally at bedtime for a duration of up to 12 months
<3 months: Safety and efficacy not established
3 to <6 months: Administer 50 mg/kg ( 40 mg/kg of ceftazidime and 10 mg/kg of avibactam) intravenously thrice daily for 7 to 14 days.
6 months to <2 years: Administer 62.5 mg/kg (50 mg/kg of ceftazidime and 12.5 mg/kg of avibactam) intravenously thrice a day for 7 to14 days
2 years to <18 years: Administer 62.5 mg/kg (50 mg/kg of ceftazidime and 12.5 mg/kg of avibactam) intravenously thrice a day for 7 to 14 days; Do not exceed 2.5 g/dose
methenamine/methylene blue/ hyoscyamine/ sodium phosphate monobasic/ phenyl salicylate
Irritative Voiding Symptoms:
Below 6 yrs: Safety & efficacy were not established
Above 6 yrs: Symptoms of UTI or diagnostic procedures: one tablet/capsule orally every 4 times a day with plenty of fluids
for Infants, Children, and Adolescents <30 kg:
Take a daily dose of 25 to 50 mg/kg orally in 2 divided doses
for Children and Adolescents ≥30 kg:
Take a dose of 375 to 750 mg orally two times a day for 5 to 14 days
For acute infections, 15 mg/kg orally in divided doses 2-4 times daily
For severe infections, 30-40 mg/kg orally divided 2-4 times daily
Not indicated in newborns
Indicated for chronic urinary tract infections:
Initial dose:12mg/kg/day orally divided every 6-8 hours on an empty stomach
Maintenance dose:250mg orally every 6-8 hours. Do not exceed 1.5g/day
Future Trends
References
https://www.ncbi.nlm.nih.gov/books/NBK470195
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» Home » CAD » Infectious Disease » Bacterial Infections » Urinary Tract Infections
A urinary tract infection (UTI) is a bacterial infection that affects the bladder and its surrounding components. Without symptoms, bacteriuria does not constitute a UTI. Urinary urgency, frequency, dysuria, and suprapubic pain are common symptoms.
Many UTIs resolve independently; however, many patients seek treatment for symptomatic relief. The treatment aims to prevent the disease from progressing to the kidneys or developing into upper tract infection or pyelonephritis, which can damage the delicate nephron structures and result in hypertension.
Urinary tract infections are among the most common bacterial infections in women. Females are more likely than males to get urinary tract infections with a ratio of 4:1.
UTIs affect 40% of women in the United States, making them one of the most prevalent infections in women. UTIs in circumcised males are infrequent; by definition, every male UTI is considered complex.
Over 60% of women acquire infection at least once in their lifetime, with a yearly infection rate of 10%. Recurrences are frequent, with approximately half of the infected women developing another infection within the same year.
The bladder mucosal membrane is infiltrated by bacteria, which causes cystitis, an inflammatory response. Enteric coliforms, which commonly live in the periurethral vaginal introitus, are the leading cause of UTIs. These bacteria infiltrate the bladder through the urethra and cause UTIs.
Sexual intercourse promotes the spread of bacteria into the bladder. Bacteria responsible for UTIs contain adhesins on their surface that enable them to adhere to the urothelial mucosal membrane.
Furthermore, a small urethra facilitates uropathogenic infiltration of the urinary system. Premenopausal women have high lactobacilli concentrations in the vagina and an acidic pH, which prevents uropathogenic colonization. Antibiotics, on the other hand, can nullify this protective effect.
The most common bacteria associated with UTIs are Escherichia coli and Klebsiella. Women are more likely to have urinary tract infections because pathogenic bacteria ascend from the rectum and perineum. Additionally, women’s urethras are shorter than men’s, which increases their vulnerability to UTIs.
Blood-borne bacteria cause some uncomplicated UTIs. UTIs are relatively frequent following a kidney transplant. The use of immunosuppressive medications and vesicoureteral reflux are the two triggers. UTIs can also be caused by sexual activity, diaphragms, and spermicides.
Other risk factors include:
Most UTI symptoms can continue for several days, even with effective antibiotic therapy. The quality of life could be poor in women who experience recurring UTIs.
These recurrences occur in about 25% of women within six months. Despite the low mortality rates, UTIs are highly morbid. In addition to the unpleasant symptoms, management is prohibitively expensive.
Common residual effects include missing work and school; occasionally, hospitalization is necessary due to the intensity of the symptoms.
Factors that contribute to poor prognosis:
20 - 40
mg/kg
Tablet
daily in 3 to 4 divided doses
imipenem/cilastatin/relebactam
1.25
g
Solution
Injection
every 6 hours
4 - 14
days
Uncomplicted:250mg intravenous every 6 hours
Complicated:500mg intravenous every 6 hours
Dose Adjustments
Renal impairment
CrCl<5 ml/min/1.73m2: Only use IV if hemodialysis will start within 48 hours
CrCl≤20 ml/min/1.73m2 :125-250mg IV every 12 hours
CrCl 21-40 ml/min/1.73m2: 125-250mg IV every 12 hours
CrCl 41-70 ml/min/1.73m2: 250mg IV every 8 hours
CrCl≥71 ml/min/1.73m2: 250mg IV every 6 hours
Indicated for chronic urinary tract infections:
Initial dose:12mg/kg/day orally divided every 6-8 hours on an empty stomach
Maintenance dose:250mg orally every 6-8 hours. Do not exceed 1.5g/day
Dose Adjustments
Renal impairment
The serum creatinine (SCr) levels in the blood determine the recommended frequency and amount of the medication to be taken. If the SCr level is between 1.8-2.5 mg/dL, the medication should be taken every 12 hours, with a maximum daily dose not exceeding 1 g. However, if the SCr level is more significant than 2.5 mg/dL, the medication is not recommended
500mg-1g intramuscular or intravenous every 8 to 12 hours. Do not exceed 8g/day
Indicated for Urinary Tract Infection Without Complications:
1
g
powder for injection
Intravenous (IV)
every 12 hrs
250 to 500 mg of ciprofloxacin in case of mild to moderate UTI
It must be administered orally every 12 hours for 7 to 14 days
400 mg of norfloxacin should be given twice daily to females for 3 days and to males for 5 days
400 mg of norfloxacin should be given twice daily to females for 3 days and to males for 5 days
methenamine/sodium salicylate/benzoic acid
Indicated for the prevention of UTI
2 tablets orally every 12 hours
Use this medication only after the UTI has been eradicated through any other appropriate antibiotic
methenamine is indicated for suppression or prophylaxis for chronic recurring urinary infections when long-term therapy is required
sodium salicylate is used as an analgesic
benzoic acid evokes weak antibacterial and antifungal properties
It helps to acidify the urine
methenamine/sodium acid phosphate
Indicated for Urinary Tract Infection as Prophylaxis
Initial dose: two tablets orally four times a day with fliud
Maintenance dose: one-two tablets orally two times a day
It should only be administered after the eradication of a urinary tract infection using other antibiotics
macrocrystals: Administering an oral dose of 50-100 mg every 6 hours is recommended for seven days or until three days after obtaining a urine sample free from contamination
monohydrate/macrocrystals: Administering 100 mg orally every 12 hours for seven days or until three days after obtaining a sterile urine sample
Long-term suppression/prophylaxis: Administering 50-100 mg of macrocrystals orally at bedtime for a maximum duration of 12 months
Indicated for prophylaxis of urinary tract infection
1 capsule/tablet orally every 6 hours sufficiently with fluids
Use only after the complete removal of urinary infection by any other antibiotics
methenamine is indicated for suppression or prophylaxis of chronic recurrent urinary infections when there is a requirement for long-term therapy
hyoscyamine is indicated for augmented therapy of the lower urinary tract spasm and hypermotility
methenamine/methylene blue/ hyoscyamine/ sodium phosphate monobasic/ phenyl salicylate
Irritative Voiding Symptoms:
Symptoms of UTI or diagnostic procedures: one tablet/capsule orally every 4 times a day with plenty of fluids
Take a dose of 375 to 750 mg orally two times a day for 5 to 14 days
382 to 764mg given orally every 4 times a day
Dose Adjustments
Dosage modifications
Renal impairment
382 to 764mg given orally every 1-2 times a day
Administer dose of 500 mg intramuscularly or intravenously every 8 hours
Administer dose of 0.5 to 2 g daily intramuscularly or intravenously in 1 or 2 daily doses
408 mg twice a day is the dosage represented in terms of lymecycline (i.e., 408 mg of lymecycline equals 300 mg of tetracycline base). If necessary, the dose may be increased to 1,224-1,632 mg over 24 hours for severe infections
Administer 3 to 4 mg/kg/day in two divided doses every 2 times a day
Dose Adjustments
Dose modifications
Renal impairment
CrCl 20-40 mL/min: 4 to 6.5 mg/kg administered once a day or in divided dosages everyday
CrCl 40-60 mL/min: 4 to 6 mg/kg administered once a day or in divided dosages every 2 times a day
Liver impairment
dose adjustment is not required
250 mg orally 4 times daily or 500 mg twice daily in infections where other antibiotics are not effective
In the case of resistant infections, increase the dose to 500 mg 4 times daily or 1 gm twice daily
For children > 40kg only::
20 - 40
mg/kg
Tablet
Orally
daily in 3 to 4 divided doses
Indicated for chronic urinary tract infections:
Initial dose:10mg/kg/day orally divided every 6-8 hours on an empty stomach
methenamine/sodium salicylate/benzoic acid
Used for prevention of UTI
Not indicated for children below 16 years
For children more than 16 years- 2 tablets orally every 6 hours
Use this medication only after the UTI has been eradicated through any other appropriate antibiotic
methenamine is indicated for suppression or prophylaxis for chronic recurring urinary infections when long-term therapy is required
sodium salicylate is used as an analgesic
benzoic acid evokes weak antibacterial and antifungal properties
It helps to acidify the urine
Age>1 month
Administer orally divided every 6 hours for seven days at a dosage of 5-7 mg/kg/day
Prophylaxis of UTI: Administering a dosage of 1-2 mg/kg orally once daily at bedtime or in two equally divided doses
Age>12 years
macrocrystals: Administering an oral dosage of 50-100 mg every 6 hours is recommended seven days or for three days following the attainment of a urine sample free from any contaminants
macrocrystals/monohydrate: Administering a dosage of 100 mg orally every 12 hours is recommended either seven days or for three days following the attainment of a urine sample free from any contaminants
Long-term suppression /prophylaxis: Take 50-100 mg of macrocrystals orally at bedtime for a duration of up to 12 months
<3 months: Safety and efficacy not established
3 to <6 months: Administer 50 mg/kg ( 40 mg/kg of ceftazidime and 10 mg/kg of avibactam) intravenously thrice daily for 7 to 14 days.
6 months to <2 years: Administer 62.5 mg/kg (50 mg/kg of ceftazidime and 12.5 mg/kg of avibactam) intravenously thrice a day for 7 to14 days
2 years to <18 years: Administer 62.5 mg/kg (50 mg/kg of ceftazidime and 12.5 mg/kg of avibactam) intravenously thrice a day for 7 to 14 days; Do not exceed 2.5 g/dose
methenamine/methylene blue/ hyoscyamine/ sodium phosphate monobasic/ phenyl salicylate
Irritative Voiding Symptoms:
Below 6 yrs: Safety & efficacy were not established
Above 6 yrs: Symptoms of UTI or diagnostic procedures: one tablet/capsule orally every 4 times a day with plenty of fluids
for Infants, Children, and Adolescents <30 kg:
Take a daily dose of 25 to 50 mg/kg orally in 2 divided doses
for Children and Adolescents ≥30 kg:
Take a dose of 375 to 750 mg orally two times a day for 5 to 14 days
For acute infections, 15 mg/kg orally in divided doses 2-4 times daily
For severe infections, 30-40 mg/kg orally divided 2-4 times daily
Not indicated in newborns
Indicated for chronic urinary tract infections:
Initial dose:12mg/kg/day orally divided every 6-8 hours on an empty stomach
Maintenance dose:250mg orally every 6-8 hours. Do not exceed 1.5g/day
https://www.ncbi.nlm.nih.gov/books/NBK470195
A urinary tract infection (UTI) is a bacterial infection that affects the bladder and its surrounding components. Without symptoms, bacteriuria does not constitute a UTI. Urinary urgency, frequency, dysuria, and suprapubic pain are common symptoms.
Many UTIs resolve independently; however, many patients seek treatment for symptomatic relief. The treatment aims to prevent the disease from progressing to the kidneys or developing into upper tract infection or pyelonephritis, which can damage the delicate nephron structures and result in hypertension.
Urinary tract infections are among the most common bacterial infections in women. Females are more likely than males to get urinary tract infections with a ratio of 4:1.
UTIs affect 40% of women in the United States, making them one of the most prevalent infections in women. UTIs in circumcised males are infrequent; by definition, every male UTI is considered complex.
Over 60% of women acquire infection at least once in their lifetime, with a yearly infection rate of 10%. Recurrences are frequent, with approximately half of the infected women developing another infection within the same year.
The bladder mucosal membrane is infiltrated by bacteria, which causes cystitis, an inflammatory response. Enteric coliforms, which commonly live in the periurethral vaginal introitus, are the leading cause of UTIs. These bacteria infiltrate the bladder through the urethra and cause UTIs.
Sexual intercourse promotes the spread of bacteria into the bladder. Bacteria responsible for UTIs contain adhesins on their surface that enable them to adhere to the urothelial mucosal membrane.
Furthermore, a small urethra facilitates uropathogenic infiltration of the urinary system. Premenopausal women have high lactobacilli concentrations in the vagina and an acidic pH, which prevents uropathogenic colonization. Antibiotics, on the other hand, can nullify this protective effect.
The most common bacteria associated with UTIs are Escherichia coli and Klebsiella. Women are more likely to have urinary tract infections because pathogenic bacteria ascend from the rectum and perineum. Additionally, women’s urethras are shorter than men’s, which increases their vulnerability to UTIs.
Blood-borne bacteria cause some uncomplicated UTIs. UTIs are relatively frequent following a kidney transplant. The use of immunosuppressive medications and vesicoureteral reflux are the two triggers. UTIs can also be caused by sexual activity, diaphragms, and spermicides.
Other risk factors include:
Most UTI symptoms can continue for several days, even with effective antibiotic therapy. The quality of life could be poor in women who experience recurring UTIs.
These recurrences occur in about 25% of women within six months. Despite the low mortality rates, UTIs are highly morbid. In addition to the unpleasant symptoms, management is prohibitively expensive.
Common residual effects include missing work and school; occasionally, hospitalization is necessary due to the intensity of the symptoms.
Factors that contribute to poor prognosis:
https://www.ncbi.nlm.nih.gov/books/NBK470195
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