Title 9. URINARY TRACT ANTI-INFECTIVE AGENTS.pdf ✅

PHARMD GURU Page 1 INTRODUCTION:  A urinary tract infection (UTI) is an infection that affects part of the urinary tract. The urinary tract is made up of kidneys, ureters, bladder, and urethra. UTI are caused by bacteria, but some are caused by fungi and in rare cases by viruses. UTI are more common in women than men (8 : 1).  Urinary tract infection is known as lower UTI/bladder infection/cystitis, when it affects the lower urinary tract i.e. the urethra and bladder part and it is most common UTI whereas, it is known as kidney infection/pyelonephritis, when it affects the upper urinary tract i.e., the ureters and kidneys. Upper UTI is rarer than lower UTI.  Upper UTI are also more severe and life threatening if bacteria move from the infected kidney into the blood and this condition is called urosepsis, can cause low blood pressure, shock, and even death. Lower UTI are usually treated with oral antibiotics; whereas, upper UTI are treated via intravenous antibiotics. UTI can be prevented by hydration (eight glasses of water daily) and don’t hold urine for long periods of time. SYMPTOMS OF URINARY TRACT INFECTION: Symptoms from a lower urinary tract infection include:  Burning sensation and pain with urination.  Increased frequency of urination without passing much urine or feeling the need to urinate despite having an empty bladder.  Increased urgency of urination.  Bloody urine or cloudy urine. URINARY TRACT ANTI-INFECTIVE AGENTS
PHARMD GURU Page 2  Urine that has a strong odour.  Pelvic pain in women and rectal pain in men. SYMPTOMS OF A KIDNEY INFECTION INCLUDE:  Fever and flank pain usually in addition to the symptoms of a lower UTI. SYMPTOMS OF AN UPPER UTI INCLUDE:  Pain and tenderness in the upper back and sides, chills, fever, nausea and vomiting. DIAGNOSIS: Diagnosis is symptoms - based and in complicated cases a urine culture may be useful. Rarely the urine may appear bloody. In the very old and the very young, symptoms may be vague or non-specific. The most common cause of infection is Escherichia coli (80–85%), though other bacteria or fungi may rarely be the cause. If the urine contains significant bacteria, but there are no symptoms, the condition is known as asymptomatic bacteriuria. If a urinary tract infection involves the upper tract, and the person has diabetes mellitus, is pregnant, is male, or immuno-compromised, it is considered complicated. Otherwise if a woman is healthy and premenopausal, it is considered uncomplicated. In children when a urinary tract infection is associated with a fever, it is deemed to be an upper urinary tract infection. Risk factors include female anatomy, sexual intercourse, diabetes, obesity, and family history. Although sexual intercourse is a risk factor, UTIs are not classified as sexually transmitted infections (STIs). Kidney infection, if it occurs, usually follows a bladder infection, but may also result from a blood-borne infection. ANTI-INFECTIVE AGENTS EMPLOYED FOR URINARY TRACT INFECTION: Chemical classes of synthetic antibacterial agents include the sulfonamides, certain nitro heterocyclic compounds (nitrofurans), and the quinolones. These antibacterial agents find importance for the treatment of local, systemic, and/or urinary tract infections. Antibacterial agents that achieve adequate concentrations in the urine are effective for eradicating urinary tract infections with good oral
PHARMD GURU Page 3 absorption, activity against common Gram-negative urinary pathogens, and comparatively higher urinary (compared with plasma and tissue) concentrations. CLASSIFICATION OF URINARY TRACT ANTI-INFECTIVE AGENTS: A series of synthetic antibacterial agents is patterned after nalidixic acid (a naphthyridine derivative) introduced in 1963. Isosteric heterocyclic groupings in this class include: a) Quinolones: Norfloxacin, Ciprofloxacin, Ofloxacin, Lomefloxacin, Sparfloxacin, Gatifloxacin, Moxifloxacin. b) Naphthyridines: Nalidixic acid, Enoxacin. c) Miscellaneous: Furazolidine, Nitrofurantoin, Methanamine. QUINOLONES: MECHANISM OF ACTION OF QUINOLONES:
PHARMD GURU Page 4 CLASSIFICATION OF QUINOLONES: