About UTIs
The urinary tract comprises the passages through which urine is passed out of the body. It terminates at the external urethral orifice which is essentially the hole on the genitalia from where urine is expelled. The lower urinary tract is prone to infections as microbes enter through the external urethral orifice and inflames each segment of the urinary tract. It gradually spreads up the urinary tract and can eventually reach the kidney. This method of spread is known as an ascending infection and accounts for almost all urinary tract infections (UTIs). Sometimes microbes travel through the bloodstream from other sites of infection in the body to reach the kidney or urinary tract. This is less common.
Most urinary tract infections are due to bacteria. Although there are various different types of bacteria that can cause urinary tract infections, it is the bacteria from the bowels especially Escherichia coli (E.coli) that are mainly responsible for UTIs. Overall UTIs are more common in women than men largely due to the shorter urethra. This means that the bacteria, or other microorganism can quickly travel up the urethra to lodge in the bladder leading to cystitis. However, in the senior years the risk of UTIs are the same between men and women. UTIs are marked by :
- Burning pain in the urethra during urination (dysuria)
- Pain in the middle of the pelvis above the genitalia
- Frequent urination
- Urging to urinate
- Blood in the urine – microscopic or grossly visible
- Urine has an unpleasant odor.
- Cloudy urine
However, a large number of urinary tract infections particularly in the elderly are asymptomatic.
UTI Treatment in Women
The approach to treatment changes for complicated and uncomplicated urinary tract infections in women. Most cases are ascending UTIs meaning that it infects the urethra and cystitis and then spreads upwards to the ureter and kidney. In a complicated UTI, the infection has passed the bladder and involves the kidney (pyelonephritis). Phenazopyridine is used for pain, discomfort and spasm of the bladder.
Uncomplicated UTI
First-line treatment used in acute cases includes :
- Trimethoprim-sulfamethoxazole
- Nitrofurantoin monohydrate/macrocrystals
- Fosfomycin
Fosfomycin is not suitable as a first line therapy for pregnant women.
Second-line therapy involves :
- Ciprofloxacin
- Levofloxacin
- Ofloxacin
Complicated UTI
Complicated UTIs can be treated with oral antibiotics if tolerate or intravenous antibiotics may be necessary. Oral antibiotics include :
- Ciprofloxacin
- Levofloxacin
Intravenous (IV) antibiotics is necessary for patients who cannot tolerate oral therapy or infection with resistant bacteria.
- Ciprofloxacin
- Levofloxacin
- Ampicillin
- Piperacillin-tazobactam
- Doripenem
- Imipenem-cilastatin
- Meropenem
Pregnant Women
First line therapy in pregnant women includes the use of :
- Nitrofurantoin monohydrate/macrocrystals
- Amoxicillin
- Amoxicillin-clavulanate
- Cephalexin
- Cefuroxime
Fosfomycin is second line treatment in pregnancy.
UTI Treatment of Men
Urinary tract infections in men are always considered as a complicated infection. Phenazopyridine is used for pain relief and bladder spasms.
- Ciprofloxacin
- Levofloxacin
- Ofloxacin
- Norfloxacin
- Trimethoprim
- Trimethoprim-sulfamethoxazole
- Ampicillin
- Amoxicillin
- Gentamicin
- Ceftriaxone
- Ceftazidime
- Tobramycin
- Erythromycin
- Vancomycin
- Doxycycline
- Ertapenem
- Aztreonam
- Nitrofurantoin
- Rifampin
UTI’s may complicate into infections of other organs :
- Prostatitis – prostate
- Pyelonephritis – kidney
- Epididymitis – epididymis
- Orchitis – testes
UTI Treatment in Children
The types of antibiotics used in treating bacterial UTIs in children differs depending on the age of the child.
Newborns
The following antibiotics are administered intravenously in babies under 8 weeks of age.
- Ceftriaxone
- Cefotaxime
- Ampicillin
- Gentamicin
Babies
The following antibiotics are administered orally in babies between 8 weeks to 2 years.
- Sulfisoxazole
- Sulfamethoxazole and trimethoprim
- Amoxicillin and clavulanic acid
- Cephalexin
- Cefixime
- Cefpodoxime
- Nitrofurantoin – for lower UTIs
Children
The following antibiotics can also be used in children older than 2 years.
- Sulfisoxazole
- Sulfamethoxazole and trimethoprim
- Amoxicillin and clavulanic acid
- Cephalexin
- Cefixime
- Cefpodoxime
- Nitrofurantoin – for lower UTIs.
Other measures for relief of symptoms in children like urinary pain includes :
- Increase fluid intake
- Acetaminophen (paracetamol) and other NSAIDs
- Phenazopyridine hydrochloride – short term use for severe and persistent symptoms.
UTI Remedies
There are several simple lifestyle measures that can be implemented to help relieve the symptoms or reduce the frequency of recurrent infections. These remedies cannot replace the use of medication like antibiotics.
- Drink extra water to help flush out the bacteria.
- Avoid substances like caffeine, alcohol and citrus juices because this can irritate the bladder.
- Cranberries have been shown to be helpful in disrupting the attachment of bacteria to the inner lining of the bladder and urethra.
- Sitting for short periods between 20 to 30 minutes in a warm water tub can be helpful in easing some of the symptoms in children.
- A heat pad set to a warm, but not hot, setting can be applied to the abdomen to ease some of the UTI symptoms in adults.
References
- Pediatric UTIs. Medscape Reference
- UTI Treatment in Males. Medscape Reference
- Cystitis in Females. Medscape Reference
Article reviewed by Dr. Greg. Last updated on March 23, 2012
