Treatment of UTI
Studies over the past few decades have endeavored to counteract the infection and the pervasiveness of anti infective use during pregnancy was 24.5% [Nakhjavaani, F.A.; Mirsaaalehian, A.; Hamidian ,M.; Kazeemib, M.M. and Jahalaaameli, F. (2007)]. Generally the commencement of the treatment process starts after the diagnosis of the infection but these initial attempts of treating the disease can lead to problematic consequences as the treatment has to be made after the confirmation of the etiological agent. The initial treatment efforts involve the employment a variety of antimicrobial agents and this could in turn make the pathogen resistant to commonly employed drugs. Such kind of treatment is referred to as empirical treatment. Therefore, a sporadic assessment of the causative pathogens against the antimicrobial agents is necessary. The significance of the bacterial resistance towards to the commonly employed antibiotics during pregnancy has gained the interest of my scientific analysts and researchers [Hamidian ,M.; Kazeemib, M.M. and Jahalaaameli, F. (2007)]. The administration of the anti infective drugs during pregnancy should be carefully monitored to ensure the safety of the fetus as majority of the anti infective drugs are capable of crossing the placental barrier [Jahalaaameli, F. (2007)]. Synthetic antimicrobial agents belonging to the family of quinolones are generally not recommended in animals due to associated risk factors related to pregnancy but the adverse effect has not been illustrated in humans [National kidney and urologic Disease information Clearinghouse,(2010)]. Research studies have confirmed the safety of beta lactum antibiotics like penicillin and cephalosporin during pregnancy [National kidney and urologic Disease information Clearinghouse,(2010)]. However, these antibiotics are deemed to be safe due to the absence of teratogenic affects that can bring about any physiological defects in the new born fetus but is sometimes associated with allergic reactions.
Studies have also provided sufficient evidences to confirm the property of antibiotic resistance exhibited by certain pathogens against amoxicillin and ampicillin which in turn has limited their usage [Nicolle L.E (2008)]. Though studies demonstrate the efficacy of nitrofurantoin, it is ineffective againstProteus species [Salvatore .; Salvatore. S.; Cattoni, E.S. IESTO, G. ; Serati, M.; Sorice,P. and Torella.M. (2011)]. Employment of trimehoprim during the first trimester of pregnancy has resulted in cardiovascular defects in newborns [Sorice,P. and Torella.M. (2011)]. Demonstrative studies have revealed the harmful effects of suphonamides during the last two trimesters of pregnancy. Therefore, women diagnosed with asymptomatic bacteriuria are prone to experience repeated infection and continuous antibiotic treatment is recommended in such cases. However, employment of antimicrobial agents interferes with the normal gastrointestinal flora. The occurrence of bacteriuria among elderly people is a characteristic feature of genetic inconsistencies, factor of ageing and allied co-morbidities.
Factors Age – Specific
According to RAZ et al (1993). Says that estrogen status is perhaps the most important age – specific risk determinant for UTI. Estrogen promotes acidic vaginal pH and lactobacillus proliferation, which are the greatest host defenses against pathogenic colonization. Withdrawal of estrogen at the time of menopause leads to conversion of the predominant vaginal flora from lactobacillus to E coli and other Enterobacteriaceae, thus increasing the incidence of infection. A randomized, double – blind placebo – controlled trial of intravaginal estrogen replacement in postmenopausal women with recurrent UTI helped to illustrate the hormone’s protective effect. Stamm and colleagues found that 61% of the women treated with intravaginal estriol experienced restoration of lactobacilli colonization, a change that was not observed in any of the women in the placebo group. This translated into significant reduction in incidence of symptomatic UTI in the treatment group: 0.5 versus 5.9 episodes per patient year in the treatment group and controls, respectively. However, only intravaginal estrogen replacement has demonstrated risk reduction in the literature; oral replacement therapy confers no significant benefit.
According to Tambyah (2000). Said that Surgical procedures to improve incontinence are associated with increased incidence of UTI. One study found that of 1356 women over age 65 who underwent urethral sling placement, one- third reported UTI within 3 months, and nearly half within 1 year of the procedure. This difference is likely secondary to increased postvoid residual urine volumes and urinary stasis.
Residence in a long – term nursing care facility bears a strong association with UTI in the elderly female population. Although the incidence of bacteriuria in independent elderly women is 2.8 to 8.6% among institutionalized women it soars to 25% to 50% as does the risk of symptomatic infection. Much of the difference is attributable to greater prevalence of chronic comorbid conditions contributing to urodynamic abnormalities, elevated postvoid residual urine volume, poor functional status, and catheterization for incontinence. distinguishing between symptomatic and asymptomatic infection in these patients also presents a clinical challenge given the frequent alterations in mental status and lack of localizing symptoms in this population. Thus, institutionalized women are more likely to be treated inappropriately with antimicrobial therapy for asymptomatic bacteriuria. Approximately 25% of antimicrobials given for UTI in the nursing home setting are given for asymptomatic infection. As such, nursing homes are significant reservoirs for resistant organisms, and nursing home residents are at greater risk for symptomatic UTI with resistant organisms.
