Management Urinary Tract Infection. Management: Urinary Tract Infection Diagnostic Tests Curative ...
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Transcript of Management Urinary Tract Infection. Management: Urinary Tract Infection Diagnostic Tests Curative ...
Management
Urinary Tract Infection
Management: Urinary Tract Infection
• Diagnostic Tests• Curative– Specific– Supportive• Diet• Physical Activity• Prophylactic
• Preventive Health Care
Management: Diagnostic Tests
• Urinalysis• Ultrasound– rule out
hydronephrosis & renal or perirenal abscesses
– may show acute pyelonephritis
Management: Diagnostic Tests• Voiding Cystourethrogram (VCUG)
– indications:• All children younger than 5y/o• Any child with a febrile UTI• School aged girls who had 2 or more UTIs• Any male with UTI
– most common finding is vesicoureteral reflux
Management: Diagnostic Tests
• Dimercaptosuccinic Acid Scan (DMSA Scan)– functional & obstruction
anomaly– supports the diagnosis of
pyelonephritis with a finding of photopenia
– most sensitive & accurate study to demonstrate renal scarring
Mangement: Curative
• Specific– Antibiotics– Anti-pyretic– Analgesic
Mangement : Curative
• Trimethoprim-sulfamethoxazole (Co-trimoxazole)– folic acid synthesis inhibitor– given if culture & sensitivities are not yet available– effective against most strains of E.coli– dosing: 40 mkd SMX & 8 mkd TMP q 12 h– preparation: 200mg SMX & 40mg TMP/ 5ml – AE: Stevens-Johnson Syndrome, hepatitis,
cholestatic jaundice, megaloblastic anemia
Management : Curative
• Amoxicillin, Ampicillin– interferes with bacterial cell wall synthesis– also effective as TMP-SMX– dosing: 40 mkd q 8 h– preparation: 100mg/ml, 125mg/5ml, 250mg/5ml– AE: Diarrhea, indigestion, occassional rash either
urticarial or erythematous
Management : Curative
• Cephalosporins– 2nd or 3rd generation– Inhibits cell wall synthesis– dosing: 25-50 mkd q 6 h – preparation: 100mg/ml, 125mg/5ml, 250mg/5ml– AE: thrombophlebitis, diarrhea
Management : Curative
• Ciprofloxacin– inhibits DNA Gyrase and topoisomerase IV preventing
replication and repair– alternative agent for resistant microorganisms like
Pseudomonas– dosing: 20-30 mkd q 12 h– preparation: 100 mg, 250 mg, 500 mg, 750 mg,
1000 mg– AE: arthropathy, tendon damage, torsades de pointes
Management : Curative
• Gentamicin– inhibits bacterial protein synthesis– combined with ampicillin– dosing: 40 mkd q 6 h– preparation: 100mg/2.5ml, 200mg/5ml,
400mg/5ml– AE: ototoxicity, nephrotoxicity
Management : Curative
• Paracetamol– inhibits COX– anti-pyretic and analgesic– dosing: 10-15 mkd q 4 h– preparation: 125mg/5ml, 250mg/5ml– AE: ototoxicity, nephrotoxicity
Management : Curative
• Supportive– Diet• Increased oral fluid intake
– Physical Activity• Frequent voiding
– Prophylactic• Proper genital hygiene• Strict hand-washing• Avoid infrequent voiding
Management: Preventive Health Care
• At 3 years of age:– Vaccines• MMR 2• Varicela• Influenza
– Blood pressure monitoring– Nutrition counseling