CLINPHAR T3

• Cystitis/ Bladder infection

  • The most common type of UTI.
  • It usually occurs in women after engaging in sexual intercourse where bacteria are introduced into the bladder through the urethra.
  • Over 90% of cystitis are due to Escherichia coli, a bacterium normally present in the colon and rectal area.
  • Clinical presentation: Presence of pain in the lower abdomen and a low grade fever.
• Urinary tract infections (UTI)

  • These are bacterial in nature, that affects the urethra (urethritis), bladder (cystitis), ureter (ureteritis) or the kidneys (pyelonephritis).
• Urethritis

  • Is an infection of the urethra, the tube that carries urine from the bladder.
  • Clinical presentations are similar to that of cystitis.
  • In some cases, the bacteria may reach the upper urinary tract and infect the kidneys (pyelonephritis) -
• Pyelonephritis

  • Urgent treatment is required when such infections occurs because this can lead to possible loss of kidney function especially in the elderly or those with weak immune system.
  • Clinical presentation: Patients experience pain in one side of the back (flank pain) and the patient feel unwell with temperature greater than or equal to 38 Degree Celsius.
• Affected population

  • UTis occur in about 3% of girls and 1% of boys by the age of 11 years.
  • Females are more susceptible to UTI because their urethra is shorter and closer to the anus.
• MICROBIOLOGY

  The following bacteria may cause UTI:

  • Escherichia coli
  • Staphylococcus saprophyticus
  • Chlamydia trachomatis
  • Mycoplasma hominis
• Antibiotics

  These drugs are commonly active against many strains of gram-positive and gram-negative bacteria that affect not only the urinary tract but almost all the organs in the human body.
• Antibiotics should be used for one week or as prescribed by the physician to ensure that the infection is completely eradicated.

  Improper use of antibiotics may cause resistance of the infectious strain.
• Antibacterial combinations such as co-trimoxazole (sulfamethoxazole and trimethoprim) and co-trimazine (sulfadiazine and trimethoprim) are commonly used to prevent inactivation of the active drug by enzymes in the bacteria. The accompanying drug usually has a certain degree of antibacterial activity, but is mostly used for its action against the degrading enzyme.
• Urinary antiseptics may contain methenamine, methylene blue, nitrofurantoin and pipemidic acid that are either used to combat susceptible causative organisms in urinary tract infections or to prevent the formation of urinary stones.
• CLINICAL PRESENTATION

  Patients with acute bacterial prostatitis may present with the following :

  • Fever i Chills
  • Malaise
  • Arthralgias
  • Myalgias
  • Dysuria
• PROSTATITIS

  • is an inflammation of the prostate gland and surrounding tissue as a result of infection.
  • The acute form is characterized by a severe illness characterized by a sudden onset of fever and urinary and constitutional symptoms.
  • Chronic bacterial prostatitis (CBP) represents a recurring infection with the same organism (relapse).
• Digital rectal examination in patients with asymptomatic inflammatory prostatitis may reveal a normal prostate.
• TREATMENT OPTIONS FOR PROSTATITIS

  • The majority of patients can be managed with oral antimicrobial agents, such as trimethoprim-sulfamethoxazole or the fluoroquinolones (ciprofloxacin, levofloxacin).
  • When IV treatment is necessary, IV to oral sequential therapy with trimethoprim-sulfamethoxazole or a fluoroquinolone, such as ciprofloxacin or ofloxacin, would be appropriate.
• BENIGN PROSTATIC HYPERPLASIA

  • Also known as enlarged prostate
  • The prostate is a small gland that helps make semen. It's found just below the bladder. And it often gets bigger as you get older.
• TREATMENT OPTIONS FOR BPH

  • a-Adrenergic Antagonists
  • Sa-Reductase Inhibitors
  • Surgical Intervention
• a-Adrenergic Antagonists

  • Tamsulosin, Terazosin, Doxazosin, and Alfuzosin
  • They antagonize peripheral vascular al -adrenergic receptors in addition to those in the prostate. Therefore, their adverse effects include first dose syncope, orthostatic hypotension, and dizziness.
• 5a-Reductase Inhibitors

  • Dutasteride and Finasteride
  • interfere with the stimulatory effect of testosterone.
  • These agents slow disease progression and decrease the risk of complications.
  • Compared with a-adrenergic antagonists, Sa-reductase inhibitors have the disadvantages of requiring 6 months to maximally shrink an enlarged prostate, being less likely to induce objective improvement, and causing more sexual dysfunction.
• Surgical Intervention

  • Prostatectomy, performed transurethrally or suprapubically, is the gold standard for treatment of patients with moderate or severe symptoms of BPH and for all patients with complications.
• Other drugs Acting on Genito-Urinary System

  phenazopyridine, potassium citrate, and flavoxate
• Urinary antiseptics may contain methenamine, methylene blue, nitrofurantoin and pipemidic acid
• Treatment for prostatitis (oral)

  trimethoprim-sulfamethoxazole

  froroquinolones (ciprofoxacin,levofloxacin)
• Treatment for prostatitis (IV)

  trimethoprim-sulfamethoxazole

  fluoroquinolone (ciprofloxacin,ofloxacin)
• a-Adrenergic Antagonists Tamsulosin, Terazosin, Doxazosin, and Alfuzosin
• 5a-Reductase Inhibitors

  Dutasteride and Finasteride