Urine infections are a common problem in women
especially those who are young and sexually active. It is also commonly seen
during the post-menopausal phase. Infections
involving the lower urinary tract i.e. the bladder (referred to as cystitis)
and the outlet or urethra (referred to as urethritis) are usually
uncomplicated and can be treated easily. Upper
urinary tract infections affecting the kidney (referred to as pyelonephritis)
if not treated on time could follow a more complicated course and require
Patients with cystitis or bladder infection usually
complain of pain while passing urine and increased frequency and urgency for urination.
Pain may be felt when the examiner presses over the bladder or lower part of
the abdomen. Testing a urine sample in the laboratory reveals the presence of
bacteria, pus cells and/or blood. In addition to these features, patients with
pyelonephritis also suffer from nausea, vomiting, pain in the flanks and fever.
An article reviewing guidelines for the treatment
for uncomplicated urinary tract infections in non-pregnant women were recently
published in the US Pharmacist. The
guidelines were formulated by the Infectious Diseases Society of America and
the European Society for Microbiology and Infectious Diseases in 2010.
Guidelines for Lower Urinary Tract Infections - Cystitis and Urethritis
recommend the use of nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMZ) or
fosfomycin as the first choice drugs for acute uncomplicated cystitis
If these cannot be used for some reason, fluoroquinolones like ofloxacin,
ciprofloxacin and levofloxacin may be used for 3 to 7 days
fluoroquinolones are very effective, they should not be used as the first
choice. This is because excessive use of these drugs may result in bacterial
resistance, thus making these drugs ineffective when they are required for more
amoxicillin/clavulanate, cefaclor and cefpodoxime are used as alternatives to
, though they have been found to be less effective. Ampicillin or
amoxicillin used alone should be avoided to prevent the development of
If the infection recurs after treatment, the
guidelines recommend doing a culture and sensitivity testing on the urine
sample and selecting the antibiotic accordingly. The patient may need treatment
for a longer duration. The patient should also be assessed for risk factors
that may result in repeated infections.
Guidelines for Pyelonephritis or Kidney Infections
With regards to pyelonephritis, the guidelines
recommend a urine culture and sensitivity test for all patients with symptoms
suggestive of pyelonephritis. Blood cultures may also be done for hospitalized
patients. Fluoroquinolones such as
ciprofloxacin for 7 days or levofloxacin for 5 days are recommended for
patients with uncomplicated pyelonephritis. This may be preceded by a dose of injected fluoroquinolone, ceftriaxone
or a day's treatment with an aminoglycoside.
or a β-lactam antibiotic may be used along with an initial dose of ceftriaxone
or aminoglycoside as an alternative to fluoroquinolones.
Hospitalized patients with pyelonephritis may
initially be treated with an intravenous fluoroquinolone, an aminoglycoside with/
without ampicillin, an extended-spectrum cephalosporin, an extended-spectrum
penicillin or a carbapenem. The antibiotic may be changed once the culture
report is available.
The physicians should also monitor the patients for
possible drug interactions and side effects caused by these antibiotics.
1. Allana J. Sucher. Stacey Smith. Update on the Treatment of Acute
Uncomplicated Cystitis and Pyelonephritis in Women. US Pharm. 2011;