Cipla-Detailer – Boom Africa

It's Time To

RETHINK UTI MANAGEMENT

There is global consensus on uncomplicated UTI management.

Fosfomycin is recommended globally as the 1st line treatment for Uncomplicated Urinary Tract Infections.

What is UTI?

UTI is a common infection caused by bacteria that can affect several parts of a urinary tract including urethra, urinary bladder, utters or kidneys.

UTI is common in females as compared to males and mostly occurs in females who are sexually active. other risk factors include:

In Kenya ~ 3 out of 10 will recur due to increasing E.Coli resistance

Drug resistance pathogens and poor hygiene mean community-acquired infections can deteriorate into lengthy and costly infections.

It affects especially sexually active young women, and postmenopausal women. It is the most frequently encountered disease in primary medical institutions, including urology, obstetrics, and gynaecology.
More than half of healthy adult women visit the hospital with acute uncomplicated cystitis at least once in their lifetime.
Escherichia coli is the most common organism responsible for acute uncomplicated UTI, followed by Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis.

UTIs can be uncomplicated, as when affecting healthy individuals, or complicated, when affecting individuals with compromised urodynamics and/or host defenses, such as those with a urinary catheter. Uncomplicated UTI is also called Uncomplicated Cystitis.

Diagnosis

1. Causative Pathogens:

The majority of UTIs are caused by Escherichia coli (70-90% of cases) and Staphylococcus saprophyticus (5-20% of cases). Other Enterobacteriaceae are rarely isolated. Identifying the causative pathogen helps in determining appropriate treatment strategies.

2. Pyuria and Bacteriuria:

Pyuria is defined as the presence of more than 10 leukocytes per mm3 in unspun voided midstream urine. It always follows bacteriuria (presence of bacteria in urine), and its absence suggests an alternative diagnosis. This information is important for healthcare providers in confirming UTI diagnoses.

3. Significant Bacteriuria:

The traditional standard for significant bacteriuria is a colony count of ≥105 colony-forming units per milliliter (c.f.u./ml) of voided midstream urine. However, research has shown that a significant number of acute cystitis cases have lower colony counts. As per the recommendations of the Infectious Diseases Society of America (IDSA), a definition of ≥103 c.f.u./ml for cystitis and ≥104 c.f.u./ml for pyelonephritis (kidney infection) is recommended, offering better sensitivity and specificity 2.

4. Differential Diagnosis for Acute Dysuria:

In sexually active women experiencing acute dysuria (painful urination), it is important to differentiate UTIs from other conditions. Acute urethritis caused by Chlamydia trachomatis, Neisseria gonorrhoeae, and herpes simplex, as well as vaginitis caused by Candida spp. and Trichomonas vaginalis, may present with similar symptoms. Accurate diagnosis is necessary to provide appropriate treatment.

Treatment

The EAU guidelines recommend the following short-term antibiotics as the first-choice treatment for acute uncomplicated cystitis:

Fosfomycin (3 g single dose): Fosfomycin administered as a single 3 g dose using trometamol is an effective option for treating Uncomplicated UTI . This antibiotic provides convenient dosing and is highly effective against the causative pathogens.

Nitrofurantoin:
Nitrofurantoin (50 mg every 6 hours) for 7 days.
Nitrofurantoin (100 mg twice daily) for 5-7 days (macrocrystals formulation).
Nitrofurantoin is commonly prescribed for the treatment of uncomplicated cystitis. It demonstrates good efficacy and is well-tolerated by most patients.

Pivmecillinam:
Pivmecillinam (400 mg twice daily) for 3 days.
Pivmecillinam (200 mg three times daily) for 5 days.
Pivmecillinam is another recommended antibiotic for the treatment of acute uncomplicated cystitis. It exhibits good efficacy and helps to eradicate the causative pathogens.

Gaps in Current Antimicrobial Therapy:
While the above-mentioned antibiotics are recommended as the first choice by the guidelines, there are certain limitations and gaps in the current antimicrobial therapy for acute uncomplicated UTI.

Fluoroquinolones:
Fluoroquinolones, such as ciprofloxacin, are not recommended as a first-line treatment due to increasing resistance. They should be reserved for important uses other than acute cystitis. Additionally, fluoroquinolones have the potential for collateral damage, meaning they may affect the normal flora of the body, leading to adverse effects.

Amoxicillin-Clavulanate and Cephalosporins:
Amoxicillin-clavulanate and cephalosporins are not recommended as first-line options due to inferior efficacy and an increasing rate of resistance. These antibiotics may also cause more adverse effects compared to the recommended treatments.

More than half of healthy adult women visit the hospital with acute uncomplicated cystitis at least once in their lifetime.
Escherichia coli is the most common organism responsible for acute uncomplicated UTI, followed by Staphylococcus saprophyticus, Klebsiella pneumoniae, and Proteus mirabilis.

Dos and don'ts to prevent uti

Drink plenty of water (2L/day).

After using the toilet, wipe from back to front, to keep bacteria away from getting close to the urethra.

Urinate everytime after sexual intercourse.

Have cranberry juice (Important constituents in cranberry may prevent bacteria from sticking to the walls of the bladder and help prevent infection.)

Keep your diabetes under control.

Do not share your medicine with others.

Do not stop medication inbetween; take them as prescribed by the doctor.

Do not use douching or sprays in the genitals area.

Avoid wearing tight fitting pants which trap moisture as that can increase the risk of urinary tract infection.

Avoid use of spemicides (cream that kills sperms) or diaphrams for contraception.