Antibiotics for infections of the genitourinary system
Urinary and genital tract infections are an unpleasant disease caused mainly by bacteria and fungi. Antibiotics if urinary tract infection is the drug of first choice.
Asymptomatic bacteriuria is characterized by the absence of clinical symptoms, leukocyturia, sometimes Piura, and the simultaneous presence of significant bacteriuria with the same bacterial strain, at least two urine samples, selected spontaneously at intervals of 24 hours.
Asymptomatic bacteriuria mainly common among girls of school age, in patients with urinary catheters or urological abnormalities. The appearance of the disease is more common in the elderly.
The disease is considered a benign phenomenon, which over time disappears spontaneously.
Asymptomatic bacteriuria is not an indication for antibiotic treatment! The exception is pregnancy, when the infection manifests itself, approximately, 5% of all women, especially during the second trimester of pregnancy. If untreated, pregnant women may develop acute pyelonephritis, the disease can cause premature birth or low birth weight. It is therefore recommended that routine repeat culturing of the urine during pregnancy, preferably during the first visit, and then for 28 weeks.
The need for treatment with drugs such as antibiotics, for other groups of patients should be evaluated strictly individually, as toxicity is repeatedly used antibiotic of funds may outweigh their therapeutic results. Antibiotics in people with urinary catheters in infections of this type do not eliminate the bacteria, but increases the resistance and the development of multidrug resistant bacteria.
Acute cystitis mainly affects women and is the most common reason for antibiotic therapy in urinary tract infections.
The cause of acute cystitis are, almost exclusively, of endogenous bacteria that inhabit the intestinal and vaginal microflora. According to present knowledge, this type of infection is recommended, especially women three-day treatment that so significantly reduced the incidence of side effects and reduced selective pressure leading to emergence and spread of antimicrobial resistance. Such an abbreviated mode, in particular, relates to Cotrimoxazole, Trimethoprim and Fluoroquinolones.
For beta-lactam antibiotics (Amoxicillin, Ampicillin, Clavulanate, Cefuroxime, etc.) in relation to a three-day treatment, there are not enough studies confirming the arguments are about as reliable clinical effects that are present in the above-mentioned chemotherapeutic agents. Therefore, antibiotics are taken for 5 days. Recommendation seven-day hack is Nitrofurantoin. A single administration is associated with a significantly greater number of treatment failure or recurrence of the disease.
In addition, some people consider the psychological aspect, which is based on the fact that the infection symptoms usually disappear on the second or third day, and during this period a person may have doubts about the effectiveness of treatment.
Abbreviated three-day treatment with appropriate antibiotics is also sufficient to kill bacteria in the urinary tract in women and girls over 15 years.
Abbreviated treatment is not recommended during pregnancy, in children, diabetic patients and people with risk of development of complicated urinary tract infections. With the exception regarding the duration of treatment is cystitis, which is caused by the bacterium Staphylococcus saprophyticus. In this case, it is recommended that a seven day treatment course, regardless of the selected antibiotics.
Therapeutic approach to recurrent disease are complex, and may include long-term (a few weeks) antibiotics. Optimal treatment should be based on bacteriological findings and antibiogramme.
For empirical drugs introduction the drug of first choice is Nitrofurantoin because of the very low resistance of Escherichia coli and related epidemiological safety.
The second-line drugs are Trimethoprim, Cotrimoxazole, Aminopenicilline, possibly in combination with inhibitors of betalactamases, or Cefuroxime.
Fluoroquinolones have their place in empirical therapy only if there is no possibility (due to high levels of resistance to antibiotics, allergies, side effects)to use any of the above drugs.
Cotrimoxazole and Trimethoprim taken for 3 dne6j, are the most effective drugs as the target, and in empirical therapy. Eradication of bacteriuria is indicated on the level > 90%.
The only limitation of empirical therapy is the level of resistance of uropathogens (E. coli) to Cotrimoxazole, which is not in this area to exceed 15% high, 20%. The reason for this is the close relationship of in vitro susceptibility and opportunities for effective eradication of the infection.
The data concerning the evaluation of antibiotic resistance of bacteria isolated in acute urinary tract infections, in our country show the average frequency of resistance of E. coli in 2011 to co-trimoxazole at 24.1% (of the total number 2683 tested strains).
Aminopenicilline (Ampicillin, Amoxicillin) for empirical use in our conditions, the due to the relatively high resistance which, in accordance with research information (2011), on average, is achieved in the case of E. coli 43%. From the point of view of bioavailability, the preferred drug is Amoxicillin, whose absorption after oral administration higher than that of Ampicillin and resorption are less affected by food intake.
At that time, as the main mechanism of resistance to penicillins is the production of beta-lactamase type TEM-1-2, empirical choice Aminopenicilline-protected inhibitors (Ampicillin/Sulbactam, Amoxicillin/Clavulanate) in areas with high resistance of E. coli significantly increases the chances of successful treatment. Aminopenicillins advantage is high efficiency for strains of enterococci, whose role in the occurrence of urinary tract infections cannot be overlooked. On the other hand, according to some experts, beta-lactam antibiotics in the treatment of urinary tract infections in General, less effective than Cotrimoxazole, and Fluoroquinolones. This applies both to Aminopenicillins and Cephalosporin antibiotics. Oral first generation Cephalosporins (e.g., Cephalexin) and second generation (e.g. Cefuroxime) to some extent are an alternative inhibitory Aminopenicillins, especially in cases of allergic reactions to Penicillin when no cross-Allergy to Cephalosporins. The only difference in their antibacterial activity is the inefficiency of enterococci to Cephalosporins, second-generation Cephalosporins have a broader spectrum of effectiveness in the sphere of the gram-negative flora and excellent stability to the action of the usual types of beta-lactamase.
Nitrofurantoin in the presence of E. coli is the most effective, according to relevant studies, the average resistance in our country is 2.3%. On the other hand, another quite significant uropathogen Proteus Mirabilis is naturally resistant to Nitrofurantoin. In the older age groups, this medicine usually should not be introduced because of the increased risk of pulmonary side effects.
Chinolone are chemotherapeutics, antibacterial activity which, in the case of urinary infections is one of the most high, and comparable with the effect of Cotrimoxazole. Bacterial strains resistant to the old Hinolonam, nalidixic and oxolinic acid can also be cross-resistant to the modern fluorinated Chinolones (Ciprofloxacin, Ofloxacin, Levofloxacin), or the bacteria can develop resistance during treatment. Indiscriminate use of Fluoroquinolones in urogenital region can lead to a significant spread of resistance, as the urinary and other, particularly respiratory bacterial pathogens.
Diagnosis and treatment of prostatitis belongs solely in the hands of urologist. The penetration of most antimicrobial drugs into the prostate, usually limited. The acute form requires parenteral treatment, preferably for at least two weeks. For the treatment fit Aminopenicillin in combination with beta-lactamase inhibitors, Cephalosporins of higher generations, Cotrimoxazole, Aminoglycosides in combination with beta-lactamase antibiotics and Fluoroquinolones.
It is believed that in acute inflammation of tissue availability of all of the claimed compositions is sufficient.
In the case of chronic infections should preferably use drugs with reliable penetration even without having an acute inflammation. Reliable in this respect, only Trimoxazole, Trimethoprim and Fluoroquinolones. Common treatment for chronic prostatitis is extended to 4-6 weeks or longer.
Epidymitis and orchitis
Diagnosis and treatment of acute epididymitis is vested exclusively in the hands of the urologist. Bacterial etiology of epidemicity in adults corresponds to the most common uropathogens and Chlamydia trachomatis.
In experiential therapy from the perspective of the spectrum of activity and pharmacokinetic properties occupy an important place Fluoroquinolones. In our environment, in particular, apply Levofloxacin or Ofloxacin.
As for laboratory-confirmed chlamydial infection, the drug of first choice is Doxycycline at a dose of 200-300 mg per day for at least two weeks. Another alternative is presentedMacrolides (Spiramycin, Azithromycin, Clarithromycin) with the same duration of the therapeutic course as Doxycycline and Fluoroquinolones.
Urethritis in men
About half negonokokkovi acute urethritis is caused by the bacterium Chlamydia trachomatis, in other cases, the disease is responsible of urogenital Mycoplasma and Ureaplasma urealyticum, and rarely Mycoplasma genitalium.
Diagnosis of infectious agent is complicated by the fact that the us class is a ubiquitous microbe that is present in urethral secretions of healthy men.
In accordance with agents, the disease is more closely related to sexually transmitted infections than a UTI.
Treatment the drug of first choice is Doxycycline or Macrolides.
For some people, the cause of the infection remains uncertain. For these cases, characterized by repeated relapse.
When gonococcal infections are the drugs of choice Ceftriaxone or Azithromycin as an alternative – Ofloxacin. Treatment, however, should always be based on the definition of sensitivity from the specific drug in the laboratory due to the significant increase of resistance of Neisseria gonorrhoeae, in particular, to generation fluoroquinolone chemotherapeutic drugs.
In the case of ineffectiveness of treatment of urethritis the aforementioned antibiotics should consider the presence of Trichomonas vaginalis and, if you suspect this etiology, to enter of Metronidazole (2 g) one time.
Acute uncomplicated pyelonephritis
The spectrum of causative agents of the disease is the same as for acute cystitis. This also corresponds to the choice of drugs intended for empirical treatment. The duration of therapy is 10 to 14 days.
More severe forms that require hospitalization, and recurrent infections should be treated with parenteral antibiotics and, in accordance with further progress, to continue taking oral medications.