Urinary Antiseptic

• What are the main urinary antiseptics mentioned in the study material?

  • Nitrofurantoin
  • Nalidixic acid
  • Methanamine
  • Fluoroquinolones
  • Sulfonamides
  • Cotrimoxazole
• What is an antimicrobial agent?

  A chemical substance that inhibits or kills microorganisms
• How does an antibiotic differ from an antimicrobial agent?

  An antibiotic is produced by microorganisms to inhibit or kill other microorganisms
• What is the primary function of an antiseptic?

  To inhibit bacterial growth in vitro and in vivo
• What is the role of a disinfectant?

  To kill microorganisms in a non-living environment
• In which populations are UTIs most prevalent?

  Women of child-bearing age and the elderly population
• What is the most common pathogen causing uncomplicated UTIs?

  E. coli
• What is the function of urinary antiseptics?

  To suppress bacteriuria in the urine
• Why are urinary antiseptics often administered with acidifying agents?

  Because low pH is an independent inhibitor of bacterial growth in urine
• Which urinary antiseptic is active against many urinary tract pathogens but not Proteus or Pseudomonas?

  Nitrofurantoin
• What enhances the activity of Nitrofurantoin?

  Acidification of the urine
• What are the adverse effects of Nitrofurantoin?

  Gastrointestinal intolerance, hypersensitivity, peripheral neuritis, hematologic disorders, liver damage, and pulmonary reactions
• In which conditions is Nitrofurantoin contraindicated?

  Renal impairment, pregnancy, and neonates
• What do methenamine mandelate and methenamine hippurate release at pH levels lower than 5.5?

  Formaldehyde
• Why are methenamine drugs not usually active against Proteus?

  Because Proteus organisms alkalinize the urine
• What is the first quinolone drug used clinically?

  Nalidixic acid
• What are the toxic effects of Nalidixic acid?

  Gastrointestinal irritation, glycosuria, skin rashes, phototoxicity, visual disturbances, and CNS stimulation
• What is the mechanism of action of fluoroquinolones?

  They inhibit topoisomerase II (DNA-gyrase) and topoisomerase IV
• How do fluoroquinolones differ from first-generation quinolones?

  Fluoroquinolones have substitutions that increase antibacterial activity and tissue penetration
• What are the generations of fluoroquinolones and their characteristics?

  1st Generation:

  • Nalidixic acid
  • G-ve activity, except Pseudomonas
  • Uncomplicated UTI

  
  

  2nd Generation:

  • Norfloxacin, Lomefloxacin, Ofloxacin, Ciprofloxacin
  • G-ve + Pseudomonas, some G+ve
  • Indications: UTI, respiratory infections, STDs, pyelonephritis

  
  

  3rd Generation:

  • Levofloxacin, Sparfloxacin, Gatifloxacin, Moxifloxacin, Grepafloxacin
  • Same as 2nd + ↑ G-ve and pen-sensitive Strep. pneumoniae
  • Indications: exacerbated acute chronic bronchitis, community-acquired pneumonia

  
  

  4th Generation:

  • Trovafloxacin
  • Same as 3rd + ↑ anaerobic coverage
  • Indications: intra-abdominal infections, PID, nosocomial pneumonia
• What are the side effects of fluoroquinolones?

  Arthropathy, Achilles tendonitis, crystalluria, gastrointestinal disturbances, and photosensitivity
• What rare but dangerous side effects are associated with fluoroquinolones?

  Cardiac issues like QT prolongation, CNS effects, hepatotoxicity, and hematuria
• What drug interactions should be avoided with fluoroquinolones?

  Antacids and milk products containing Al++, Mg, Fe, Zn, Ca
• What are some species of Haemophilus mentioned in the study material?

  Haemophilus spp.
• Which bacteria are associated with pneumococcal pneumonia?

  Streptococcus pneumoniae and Streptococcus fecalis
• What is the significance of the 3rd and 4th generation in pneumococcal pneumonia?

  They are particularly effective against pneumococcal pneumonia.
• What class of antibiotics do fluoroquinolones belong to?

  Fluoroquinolones
• What is a common side effect of fluoroquinolones related to joints?

  Arthropathy
• Why are fluoroquinolones not recommended for pregnant women and nursing mothers?

  Due to potential risks to the developing fetus and nursing infant.
• What serious condition can fluoroquinolones cause in geriatric patients?

  Achilles tendonitis leading to tendon rupture.
• What is crystalluria and which fluoroquinolones are exceptions?

  Crystalluria is the presence of crystals in urine; exceptions are levofloxacin, gatifloxacin, moxifloxacin, and trovafloxacin.
• What gastrointestinal disturbances can fluoroquinolones cause?

  GIT disturbances such as nausea and diarrhea.
• What is a rare but dangerous cardiac side effect of fluoroquinolones?

  QT prolongation leading to Torsades de pointes.
• Which fluoroquinolone was withdrawn due to safety concerns?

  Grepafloxacin
• What CNS side effects can occur with fluoroquinolones?

  Insomnia, dizziness, anxiety, and seizures.
• Which fluoroquinolone is particularly associated with hepatotoxicity?

  Trovafloxacin
• What is hematuria and in which patients is it a concern with fluoroquinolones?

  Hematuria is the presence of blood in urine, especially in G-6-PD deficient patients.
• What can decrease the absorption of fluoroquinolones?

  Antacids and milk products containing Al++, Mg, Fe, Zn, Ca.
• What interaction occurs between fluoroquinolones and NSAIDs?

  They can cause CNS disturbances due to displacement of GABA from its receptors.
• What is the effect of fluoroquinolones on theophylline levels?

  They can increase theophylline levels, leading to toxicity.