Urinary Tract Infections and Pyelonephritis

In urinary tract infections (UTIs), patients receive hospital-acquired infections that pass to the urinary tract through catheterization for hospitalized patients. However, those in the community acquire the infections through different routes of transmission that directly enter the urinary system or through blood due to systemic infections. Catheters provide the surface for the formation of biofilms, which are mostly resistant to antibiotics (Hooton et al., 2010). The bacteria bind the uroepithelial mucosal host cells to cause inflammation, hence the disease symptoms.

Pharmacotherapy for UTIs involves the use of levofloxacin or other antibiotics depending on the disease causative pathogen. A three-day antimicrobial regimen is considered for women below the age of 65 years, while a five-day regimen is required for CAUTI patients who are not severely ill (Hooton et al., 2010). However, seven days duration is recommended for patients with prompt resolution, while those with a delayed responses should be in treatment for 10-14 days.

The pathophysiology of pyelonephritis starts with the invasion of bacteria into renal parenchyma after ascending from the lower urinary tract or through hematogenous sources. The bacteria use adhesins to bind on renal cells and release virulence factors and toxins that cause inflammation (Gupta et al., 2011). This leads to the occurrence of symptoms that worsen when the disease progresses.

Pyelonephritis has different options of treatment. Patients can take fluoroquinolones, but in the case of resistance, ceftriaxone or an aminoglycoside can be used (Gupta et al., 2011). For instance, patients can start with 1000mg extended-release dose of ciprofloxacin for seven days or 750mg of levofloxacin for five days (Gupta et al., 2011). Also, oral trimethoprim-sulfamethoxazole, oral beta-lactam agents, or aminoglycosides of varying doses can be utilized depending on the response of the infection to the different drugs or resistance factors, among others.

References

Gupta, K., Hooton, T. M., Naber, K. G., Wullt, B., Colgan, R., Miller, L. G.,… & Soper, D. E. (2011). International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clinical infectious diseases, 52(5), e103-e120.

Hooton, T. M., Bradley, S. F., Cardenas, D. D., Colgan, R., Geerlings, S. E., Rice, J. C.,… & Nicolle, L. E. (2010). Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious Diseases, 50(5), 625-663.

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