Urinary tract infections in women: diagnosis and treatment
Article Abstract:
Urine passes from each kidney through a ureter, to the bladder and, finally, out through the urethra. Infections of the urinary tract (UTIs) are common among women and are estimated to cost one billion US health care dollars per year. Symptoms of bladder infection (cystitis) or lower urinary tract infection include frequency and urgency of urination, pain on urination, voiding small amounts of urine, incontinence and discomfort in the bladder region. These symptoms must be distinguished from those caused by vaginitis, sexually transmitted diseases and irritations of the urethra. Upper and lower urinary tract infections are classified as complicated when structural abnormalities are discovered (usually when antibiotic treatments repeatedly fail), indwelling urinary catheters are needed to drain urine from the bladder, recent antibiotic therapy has failed, the patient has diabetes, or there is a history of kidney infection or three UTIs in one year. Uncomplicated lower urinary tract infections should be treated with a short course of antibiotics; a single dose or three-day regimen of medication is currently recommended. In complicated cases, antibiotic therapy should be prescribed for a minimum of seven days. Upper urinary tract infections of the kidney occur, without overt symptoms, in one-third of patients with cystitis. Symptoms of overt upper urinary tract infection include back pain, abdominal pain, fever, shakes, headache, nausea, vomiting and body weakness. With upper urinary tract infections, the results of urine cultures and sensitivity tests are used to determine which antibiotic will be most effective in treating the infection. Trimethoprim-sulfamethoxazole is considered to be more effective than ampicillin for treating suspected kidney infections. During an acute kidney infection, hospitalization and administration of intravenous antibiotics are often required. In patients who are less ill, uncomplicated kidney infections can usually be treated with oral antibiotics for 14 days. Although the value of repeating urine cultures after therapy is unclear, they are not required after treatment of uncomplicated cystitis. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Annals of Internal Medicine
Subject: Health
ISSN: 0003-4819
Year: 1989
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Therapy for women hospitalized with acute pyelonephritis: a randomized trial of ampicillin versus trimethoprim-sulfamethoxazole for 14 days
Article Abstract:
Acute pyelonephritis (AUPN) is a condition characterized by inflammation of the kidneys and pelvis. It is caused by bacterial infection, and is a common disease in women. Estimates indicate that 100,000 women are hospitalized annually with AUPN. The effectiveness of the antibiotic ampicillin (Amp) plus gentamicin (GM) was compared with the effectiveness of trimethoprim-sulfamethoxazole (TMP/SMZ) plus GM in treating AUPN in 85 hospitalized women. Drug treatment was administered for 14 days, and included either 1 gram of intravenous Amp every 6 hours for 3 days, followed by 500 milligrams (mg) given orally 4 times a day, or TMP/SMZ 160/800 mg given twice a day. Both treatment regimens included GM, which was administered intravenously every eight hours. Forty-four women were in the Amp treatment group and 41 were in the TMP/SMZ treatment group. The most common symptoms of AUPN were fever, nausea, vomiting, and urinary tract infection (UTI), which occurred in 85 percent of the patients. The bacteria Escherichia coli was identified in the urine of 91 percent of the patients. Thirty-two percent of the women in the Amp group had bacterial infections that were resistant to Amp, while none of the patients in the TMP/SMZ group had resistant infections. Both groups showed good clinical improvement. Reinfection was a problem in 8 percent of the TMP/SMZ group and 11 percent of the Amp group. Side effects of Amp treatment affected 10 percent of the patients and included rash and diarrhea. Nausea and vomiting occurred in 7 percent of the TMP/SMZ group. The TMP/SMZ treatment protocol was more cost effective than the Amp treatment and did not require alteration because of drug resistance in microorganisms. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Infectious Diseases
Subject: Health
ISSN: 0022-1899
Year: 1991
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Prevention of catheter-associated urinary tract infection with a silver oxide-coated urinary catheter: clinical and microbiologic correlates
Article Abstract:
Urinary tract infections (UTIs) are the most common nosocomial infection (acquired in the hospital). They result in increased health care costs, extended hospital stays, bacteremia (bacteria in the blood), and increased mortality. The use of antibiotic-coated catheters or catheters lubricated with a hydrophilic polymer, and the application of povidone-iodine or soap preparations to the female urethral opening have not substantially reduced the occurrence of nosocomial UTIs. A silver oxide-coated urinary catheter and its effect on the reduction of nosocomial UTIs were evaluated in 482 hospitalized patients; 207 received the silver oxide-coated catheter, and 275 received the control catheter. Subjects and controls were closely matched. Antibiotic treatment prior to catheterization reduced the incidence of UTIs in males. Women who received the silver oxide-coated catheter were better protected against UTI than male participants, even without prior antibiotic therapy. Infections due to gram positive organisms predominated in the absence of antimicrobial therapy, and catheter violations, and with the control catheter. Gram negative organisms and candidal UTIs were more common after long-term catheterization (more than seven days). Candidal infections occurred more frequently in women in general, and in those treated with antibiotics. (Consumer Summary produced by Reliance Medical Information, Inc.)
Publication Name: Journal of Infectious Diseases
Subject: Health
ISSN: 0022-1899
Year: 1990
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