I. Pathogenic bacteria
1, the most common causative agent of urinary tract infection is Escherichia coli, followed by Proteus mirabilis, Klebsiella, Staphylococcus, Pseudomonas aeruginosa, etc.
2, acute and uncomplicated urinary tract infections, about 85% caused by Escherichia coli.
3.Infections caused by urinary tract obstruction, malformation, neurogenic bladder, diabetes mellitus or after the operation of instruments are predominantly caused by Aspergillus, Klebsiella and Pseudomonas aeruginosa.
Staphylococcal infections are more common in men under 15 years of age; in men over 55 years of age or in poor general condition, staphylococcal infections increase; in women aged 16-35 years, staphylococcal infections are second only to Escherichia coli, accounting for about 10%-15%.
Second, the antibacterial drug treatment of acute pyelonephritis
1, first collect urine to do urine sediment smear, bacterial culture and antibiotic sensitivity test, according to the results of the selection of effective antibiotics.
2, such as gram-negative bacilli, cephalosporins, broad-spectrum penicillin, aminoglycoside antibiotics, cotrimoxazole, quinolones synthetic drugs can be used.
3. The use of antibiotics continues until the body temperature is normal, the systemic symptoms disappear, and 2 weeks after the bacterial culture is negative.
III. Antibacterial drug treatment for chronic pyelonephritis
1.Refer to acute point 1 above.
2, the application of antibiotics for at least 2-3 weeks, the need to continue the long-term application of small doses of oral antibiotics to inhibit bacterial growth, sometimes maintained for more than a few months.
3, During treatment, repeatedly check the urine for white blood cells and bacterial cultures.
Fourth, the antibacterial drug treatment of acute cystitis
1, the drug of choice for simple cystitis: quinolone antibacterial drugs. Single dose or 3-day course is advocated abroad, and currently the most used is 3-day short course therapy.
2, if the symptoms do not disappear, urine pus cells continue to exist, the culture is still positive, should be considered resistant or there are infection triggers, to replace the appropriate antibiotics in a timely manner, extend the application time.
V. Acute urethritis
1, the preferred drug: quinolone antibacterial drugs.
2, the use of haloperidol in combination with sulfonamides, the effect is satisfactory.
Antimicrobial drug therapy is the main treatment for urinary tract infections, and it is recommended to choose the drug according to the drug sensitivity test.
Empirical antibacterial drug therapy can be administered first to patients with urinary tract infections.
I. Characteristics of the causative organisms of different infection types
1, simple urinary tract infection: (1) the pathogenic bacteria are mainly Escherichia coli (70%-95%) and Staphylococcus putrefaciens (5%-19%); (2) the common pathogens of asymptomatic bacteriuria in pregnancy are aerobic Gram-negative bacilli and Staphylococcus haemolyticus.
2, complex urinary tract infections: (1) have a broader spectrum of bacteria and are more likely to be drug-resistant (especially treatment-related complex urinary tract infections), as well as a combination of urologic disease (anatomic or functional) or underlying disease that predisposes to urinary tract infection; (2) urine cultures commonly include Escherichia coli, Aspergillus, Klebsiella, Pseudomonas, Serratia marcescens, and Enterococcus, mostly Enterobacter Section (60% to 75%), the most common of which is Escherichia coli, especially in patients with their first infection.
Second, the treatment of acute simple cystitis in non-pregnant women
1. Short-course antibacterial drug therapy can be used. Short-course therapy is divided into single-dose therapy (single-dose therapy) and 3-day therapy (3-day therapy).
2. Short-course therapy: Phosphomycin aminotriol, pimecillin, furantoin, quinolones, second- or third-generation cephalosporins can be used. The vast majority of patients can turn urinary bacteria negative after treatment with single-dose therapy or 3-day therapy.
3.? Symptomatic treatment: Drink more water during treatment, take oral sodium bicarbonate or potassium citrate to alkalize urine, and use flavonoid permethrin salts or anticholinergic drugs to relieve bladder spasm and reduce bladder irritation symptoms. In addition, hot compresses and hot water sitz baths in the bladder area can also reduce bladder spasm.
Treatment of acute simple pyelonephritis in non-pregnant women
1. For pyelonephritis with only mild fever and/or percussion pain in the cribriform angle, or for patients with lower urinary tract infection who have failed 3-day therapy, effective antibacterial drugs should be administered orally for 14 days.
If the drug is still not effective 48 to 72 hours after administration, effective drug therapy should be selected based on drug sensitivity testing. If bacteriuria is still present after 14 days of treatment, the drug should be changed according to the drug sensitivity test and treated for another 6 weeks.
2.For those who have fever over 38.5℃, pressure pain at the angle of the rib cage, elevated blood leukocytes, etc., or have serious systemic toxic symptoms and suspected bacteraemia, firstly, give extra-gastrointestinal administration (intravenous drip or intramuscular injection), and then change to oral antibacterial drugs (quinolones, second or third generation cephalosporins, etc.) after 72 hours of fever reduction to complete the 2-week course.
3, drug selection: ① 3rd generation quinolones (such as levofloxacin, etc.); ② semi-synthetic broad-spectrum penicillin, such as piperacillin, sulfobenzylpicillin, etc. are effective for Pseudomonas aeruginosa; ③ 3rd generation cephalosporins, such as ceftazidime, cefoperazone, etc. are more effective for Pseudomonas aeruginosa, etc.
Fourth, the treatment of recurrent simple urinary tract infection
1, re-infection: can be considered with low-dose long course of antibacterial therapy for prophylaxis.
(1) Before going to bed or after urinating during sexual intercourse every night, take one of the following drugs orally: for example, half or one tablet of SMZ-TMP, 50mg of TMP, 50mg of furantoin (to prevent renal impairment, fluid intake should be increased appropriately when using the above drugs for a long time) or 100mg of levofloxacin.
(2) In addition, oral administration of fosfomycin aminotriol every 7-10 days can be used.
(3) For menopausal women, estrogen may be added to reduce recurrence.
(4) This therapy is usually used for six months, and if recurrent relapses occur even after discontinuation of the drug, this therapy is given again for 1 to 2 years or longer.
(2) Recurrence: Sensitive antibacterial drugs should be selected according to the results of the drug sensitivity test and treated with the maximum allowable dose for 6 weeks. If this does not work, consider extending the course of treatment or switching to injectable drugs.
V. Acute simple urinary tract infection in men
1, usually only need to receive the minimum dose of 7 days of treatment can be.
2, Combined prostate infection, other febrile urinary tract infections, pyelonephritis, recurrent infections, or adult patients with suspected complicating factors leading to infection are recommended to use quinolones for 2 weeks and exclude other risk factors leading to infection.
VI. Prostatitis
Antibiotics are selected from broad-spectrum penicillin, third generation cephalosporins, aminoglycosides, fluoroquinolones (ciprofloxacin, levofloxacin, lomefloxacin, moxifloxacin, etc.), macrolides (azithromycin, clarithromycin, etc.), tetracyclines (minocycline, etc.), and sulfonamides.
The course of treatment is 2 weeks to 4 weeks to 6 weeks.
Summary
Antibiotic treatment for urinary tract infections is recommended with sensitive antibiotics, generally with a longer course for upper urinary tract infections and male accessory gonadal infections and a shorter course for lower urinary tract infections.