35.1 Urinary Anti-infectives
3 min read•june 18, 2024
can be a real pain, literally. But don't worry, there are meds that can help kick those pesky bacteria to the curb. Let's take a look at some common and how they work.
From to , these drugs target bacteria in different ways. We'll cover how they work, potential side effects, and what nurses need to know when giving them to patients. Knowing this stuff is key for keeping UTIs at bay and helping patients feel better fast.
Urinary Anti-infectives
Key features and uses of common urinary anti-infective drugs
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Comparative Efficacy and Safety of Fosfomycin and Nitrofurantoin in Acute Uncomplicated Lower ... View original
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Comparative Efficacy and Safety of Fosfomycin and Nitrofurantoin in Acute Uncomplicated Lower ... View original
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Comparative Efficacy and Safety of Fosfomycin and Nitrofurantoin in Acute Uncomplicated Lower ... View original
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- Nitrofurantoin (, )
- Broad-spectrum antibacterial activity effective against a wide range of bacteria
- Used for treating uncomplicated urinary tract infections (UTIs) such as cystitis and pyelonephritis
- Taken orally with food to minimize gastrointestinal side effects (nausea, vomiting)
- (, )
- Combination of two antibiotics with synergistic effects enhances effectiveness against bacteria
- Effective against most common UTI-causing bacteria (E. coli, Klebsiella, Enterobacter)
- Used for treating both uncomplicated and complicated UTIs, including recurrent infections
- Contraindicated in patients with sulfa allergies or due to risk of severe reactions
- ()
- Single-dose treatment for uncomplicated UTIs provides convenience and adherence
- Broad-spectrum activity against Gram-negative (E. coli) and Gram-positive bacteria (Enterococcus)
- Minimal impact on normal gut flora reduces risk of antibiotic-associated diarrhea (C. difficile)
- Methenamine (, Urex)
- Converts to in acidic urine exhibits antibacterial properties
- Used for long-term prophylaxis of recurrent UTIs to prevent frequent infections
- Requires acidic urine (pH < 5.5) for optimal effectiveness, may need concomitant acidifying agents
Mechanisms of action, side effects, and potential drug interactions
- Nitrofurantoin
- Mechanism of action: Inhibits bacterial DNA, RNA, and protein synthesis disrupting bacterial growth
- Side effects: Nausea, vomiting, headache, brown discoloration of urine
- Drug interactions: Antacids and proton pump inhibitors may decrease absorption, reducing effectiveness
- Trimethoprim-sulfamethoxazole
- Mechanism of action: Inhibits bacterial folate synthesis at two different steps, preventing bacterial growth
- Side effects: Nausea, vomiting, rash, , hyperkalemia (elevated potassium levels)
- Drug interactions: Warfarin (increased anticoagulant effect), methotrexate (increased toxicity)
- Fosfomycin
- Mechanism of action: Inhibits bacterial cell wall synthesis, leading to cell lysis and death
- Side effects: Diarrhea, nausea, vomiting, headache
- Drug interactions: Metoclopramide may decrease fosfomycin absorption, reducing effectiveness
- Methenamine
- Mechanism of action: Releases formaldehyde in acidic urine has antibacterial properties
- Side effects: Nausea, vomiting, rash, irritation
- Drug interactions: Antacids and urinary alkalinizers decrease effectiveness by raising urine pH
Essential nursing considerations when administering urinary anti-infectives
- Assess patient's allergy history and contraindications before administration to prevent adverse reactions
- Encourage adequate fluid intake to maintain urinary output and prevent (crystal formation in urine)
- Monitor renal function and adjust dosage as needed, especially in elderly patients with reduced kidney function
- Educate patients on the importance of completing the full course of antibiotics to prevent antibiotic resistance
- Assess for signs and symptoms of UTI resolution (decreased frequency, urgency, pain) or progression (fever, flank pain)
- Monitor for adverse reactions (rash, nausea, diarrhea) and report to the healthcare provider if necessary
- Ensure proper timing of medication administration in relation to meals or other drugs to optimize absorption
Patient education plan for safe and effective use of urinary anti-infectives
- Emphasize the importance of taking medications as prescribed and completing the full course to prevent antibiotic resistance
- Encourage patients to drink plenty of water (8-10 glasses/day) to maintain adequate urinary output and flush bacteria
- Advise patients to void frequently and completely to minimize bacterial growth and prevent UTI recurrence
- Teach patients to recognize signs and symptoms of UTI recurrence (frequency, urgency, pain) or treatment failure (persistent symptoms)
- Instruct patients to report adverse reactions (rash, severe nausea, diarrhea) or persistent symptoms to their healthcare provider
- Educate patients on preventive measures, such as wiping front to back and avoiding irritating products (douches, scented tampons)
- Advise patients to avoid alcohol consumption while taking methenamine, as it may cause a disulfiram-like reaction (flushing, headache, nausea)
- Encourage patients to inform their healthcare provider of all medications they are taking to avoid potential drug interactions (antacids, warfarin)
Key Terms to Review (59)
Anti-infectives: Anti-infectives are medications used to treat infections by inhibiting the growth of or killing microorganisms such as bacteria, fungi, or viruses. In the context of urinary and bladder disorders, they specifically target pathogens causing infections in the urinary tract.
Antibiogram: An antibiogram is a report that summarizes the susceptibility or resistance patterns of a specific bacterial pathogen to various antimicrobial agents. It provides critical information to guide the appropriate selection of antibiotics for the treatment of urinary tract infections and other infectious diseases.
Antimicrobial Resistance: Antimicrobial resistance is the ability of microorganisms, such as bacteria, viruses, and fungi, to resist the effects of antimicrobial drugs, including antibiotics, antivirals, and antifungals. This phenomenon can significantly impact the effectiveness of these medications in treating infections, posing a major global health concern.
Asthenia: Asthenia is a medical term that describes a condition of physical weakness and lack of energy. It can be a side effect of certain medications, including those used to treat urinary and bladder disorders.
Bacterial DNA Synthesis Inhibition: Bacterial DNA synthesis inhibition refers to the process of disrupting or preventing the replication and duplication of genetic material within bacterial cells. This mechanism of action is a key feature of certain classes of antibacterial drugs used in the treatment of various infections, particularly in the context of urinary anti-infectives.
Bacteriuria: Bacteriuria refers to the presence of bacteria in the urine, which can be an indicator of a urinary tract infection (UTI) or other underlying urinary tract conditions. It is an important term in the context of 35.1 Urinary Anti-infectives, as the detection and management of bacteriuria is a crucial aspect of treating and preventing UTIs.
Bactrim: Bactrim is a combination antibiotic containing sulfamethoxazole and trimethoprim, used to treat various bacterial infections. It is commonly prescribed for urinary tract infections (UTIs), respiratory infections, and certain types of diarrhea.
Beers Criteria: The Beers Criteria is a guideline for healthcare professionals to help improve the safety of prescribing medications for older adults, identifying potentially inappropriate medications (PIMs) that pose higher risks than benefits in this population.
Biofilms: Biofilms are complex communities of microorganisms that adhere to surfaces and are encased in a self-produced extracellular matrix. They are particularly relevant in the context of urinary anti-infectives, as biofilms can form on medical devices and contribute to persistent urinary tract infections.
Bladder: The bladder is a hollow, muscular organ located in the pelvis that serves as a storage and collection vessel for urine produced by the kidneys. It plays a crucial role in the urinary system, responsible for temporarily holding urine until it can be voluntarily expelled from the body.
Blood dyscrasias: Blood dyscrasias are abnormal conditions or disorders of the blood, often involving the cellular components such as red blood cells, white blood cells, or platelets. These conditions can be caused by various factors including medication side effects.
Blood urea nitrogen (BUN): Blood urea nitrogen (BUN) is a measure of the amount of urea nitrogen in the blood, a waste product formed in the liver from protein metabolism. Elevated BUN levels can indicate impaired kidney function or fluid imbalance.
BUN: BUN, or Blood Urea Nitrogen, is a measure of the amount of nitrogen in the blood that comes from the waste product urea. It is an important indicator of kidney function and can provide valuable insights into various medical conditions and drug therapies.
Crystalluria: Crystalluria refers to the presence of crystals in the urine. It is a condition that can occur as a result of various factors, including the use of certain medications, underlying medical conditions, or dietary factors, and is particularly relevant in the context of urinary anti-infectives.
Dysuria: Dysuria is a medical term that refers to painful or difficult urination, often accompanied by a burning sensation. It is a common symptom that can be associated with various bacterial, viral, and fungal infections, as well as other urinary tract conditions.
Erythema multiforme: Erythema multiforme is an acute, self-limiting skin condition often triggered by infections or medications. It presents with target-like lesions and may involve mucous membranes.
Escherichia coli: Escherichia coli (E. coli) is a common type of bacteria found in the lower intestine of warm-blooded organisms, including humans. It is a Gram-negative, rod-shaped bacterium that is a key player in bacterial infections, as well as a significant factor in urinary tract infections.
Exfoliative dermatitis: Exfoliative dermatitis is a severe skin condition characterized by widespread redness, scaling, and peeling of the skin. It can be caused by drug reactions, including those from urinary anti-infectives.
Fluoroquinolones: Fluoroquinolones are a class of broad-spectrum antibiotics that inhibit bacterial DNA gyrase and topoisomerase IV. They are commonly used to treat respiratory, urinary tract, gastrointestinal, and skin infections.
Fluoroquinolones: Fluoroquinolones are a class of broad-spectrum antibiotics that are widely used to treat a variety of bacterial infections. They are characterized by the presence of a fluorine atom attached to the quinolone nucleus, which enhances their antimicrobial activity and pharmacokinetic properties. Fluoroquinolones are known for their effectiveness against both Gram-positive and Gram-negative bacteria, making them a versatile choice in the treatment of infections.
Fluoroquinolones have a diverse range of applications, including their use as antibiotics, antivirals, and even antifungals. They play a crucial role in the management of various infectious diseases, from respiratory tract infections to urinary tract infections and even certain types of tuberculosis. Additionally, fluoroquinolones have been investigated for their potential as anti-COVID-19 agents, as some studies have suggested their ability to inhibit the replication of the SARS-CoV-2 virus.
Folate Antagonism: Folate antagonism refers to the inhibition or disruption of the normal function and utilization of folate, also known as vitamin B9, within the body. This process can have significant implications for various physiological processes and is particularly relevant in the context of urinary anti-infectives.
Formaldehyde: Formaldehyde is a colorless, flammable gas with a pungent odor. It is a common chemical used in a variety of industries and is also naturally produced in the human body as part of normal metabolic processes. In the context of 35.1 Urinary Anti-infectives, formaldehyde is an important consideration due to its potential role in the treatment and management of urinary tract infections.
Fosfomycin: Fosfomycin is an antibiotic medication primarily used to treat urinary tract infections (UTIs). It works by inhibiting an early stage of bacterial cell wall synthesis, preventing the formation of essential components needed for bacterial growth and replication.
Fosfomycin tromethamine: Fosfomycin tromethamine is an antibiotic used to treat uncomplicated urinary tract infections (UTIs) caused by susceptible bacteria. It works by inhibiting bacterial cell wall synthesis.
Fulminant hepatic necrosis: Fulminant hepatic necrosis is a rapid and severe liver cell death leading to liver failure. It can be caused by drug toxicity, including certain anticonvulsant drugs, infections, or metabolic disorders.
Furadantin: Furadantin is a brand name for nitrofurantoin, an antibiotic used to treat urinary tract infections (UTIs). It works by inhibiting bacterial enzyme systems, interfering with carbohydrate metabolism and cell wall formation.
G6PD Deficiency: G6PD deficiency is a genetic disorder in which the body lacks the enzyme glucose-6-phosphate dehydrogenase (G6PD), which is essential for red blood cell function. This deficiency can lead to various complications, particularly in the context of urinary anti-infectives.
Hematuria: Hematuria is the presence of blood in the urine, which can be a symptom of various underlying medical conditions related to the renal system, urinary tract, or other parts of the body. It is an important indicator that requires further evaluation and management.
Hemolytic Anemia: Hemolytic anemia is a type of anemia caused by the premature destruction or rupture of red blood cells (RBCs), leading to a reduced number of functional RBCs and impaired oxygen delivery throughout the body. This condition is particularly relevant in the context of urinary anti-infectives, as certain medications can induce or exacerbate hemolytic anemia as an adverse effect.
Hiprex: Hiprex is an antibacterial medication primarily used to prevent and treat urinary tract infections (UTIs). It works by turning into formaldehyde in the urine, which helps kill bacteria.
Klebsiella pneumoniae: Klebsiella pneumoniae is a Gram-negative, rod-shaped bacterium that is a common cause of pneumonia and other serious infections. It is a member of the Enterobacteriaceae family and is known for its ability to develop antibiotic resistance, making it a significant public health concern, particularly in the context of urinary tract infections and other urinary anti-infective treatments.
Macrobid: Macrobid is an antibiotic used to treat urinary tract infections (UTIs). It is commonly prescribed to combat bacteria in the bladder and kidneys.
Macrodantin: Macrodantin, also known as nitrofurantoin, is an antibiotic specifically used to treat urinary tract infections (UTIs). It works by inhibiting bacterial enzymes and cell wall synthesis, thereby preventing bacterial growth.
Methenamine: Methenamine, also known as hexamethylenetetramine, is a synthetic compound used as a urinary anti-infective agent. It is primarily employed in the treatment and prevention of urinary tract infections (UTIs) by inhibiting the growth of bacteria in the urinary system.
Methenamine hippurate: Methenamine hippurate is a urinary anti-infective agent used to prevent or control recurring urinary tract infections (UTIs). It works by producing formaldehyde in acidic urine, which has antibacterial properties.
Monurol: Monurol is a brand name for fosfomycin, an antibiotic used to treat uncomplicated urinary tract infections (UTIs). It works by inhibiting bacterial cell wall synthesis.
Nitrofurantoin: Nitrofurantoin is an antibiotic used to treat urinary tract infections. It works by inhibiting bacterial enzymes necessary for the synthesis of DNA, RNA, and cell wall proteins.
Older clients: Older clients are patients typically aged 65 and above who may have unique health considerations due to age-related physiological changes. These changes often necessitate specialized pharmacological approaches.
Pediatric: Pediatric refers to the branch of medicine that involves the medical care of infants, children, and adolescents. It encompasses a range of practices including pharmacology, immunizations, and treatments for various disorders.
Pharmacokinetics: Pharmacokinetics is the study of how the body affects a drug, including the processes of absorption, distribution, metabolism, and elimination. It examines the movement of drugs within the body and how these processes impact the drug's concentration and duration of action.
Photosensitivity: Photosensitivity is an increased sensitivity of the skin to ultraviolet (UV) light, often resulting in adverse reactions such as rash or sunburn. It can be a side effect of certain medications, including those used to treat urinary and bladder disorders.
Photosensitivity: Photosensitivity is a condition in which the skin becomes abnormally sensitive to sunlight or other sources of ultraviolet (UV) radiation, leading to an adverse reaction or increased susceptibility to skin damage. This term is particularly relevant in the context of certain medications and medical conditions that can cause or exacerbate photosensitivity.
Proteus: Proteus is a genus of Gram-negative bacteria that are known for their ability to cause urinary tract infections (UTIs) and other types of infections in humans. These bacteria are opportunistic pathogens, meaning they can take advantage of weakened immune systems or disruptions in the normal microbial flora to cause disease.
Pseudomonas: Pseudomonas is a genus of Gram-negative, aerobic bacteria that are known for their versatility and ability to thrive in a wide range of environments. These bacteria are particularly relevant in the context of urinary anti-infectives, as they are a common cause of urinary tract infections (UTIs) and can be challenging to treat due to their intrinsic resistance to many antibiotics.
Pyuria: Pyuria refers to the presence of white blood cells (pus cells) in the urine, which is an indicator of urinary tract infection or inflammation. This term is particularly relevant in the context of urinary anti-infectives, as it can help guide the diagnosis and treatment of various urinary tract disorders.
Septra: Septra is a combination antibiotic containing sulfamethoxazole and trimethoprim. It is commonly used to treat urinary tract infections (UTIs) by inhibiting bacterial growth.
Stevens-Johnson Syndrome: Stevens-Johnson syndrome (SJS) is a rare, serious, and potentially life-threatening skin condition that typically begins with flu-like symptoms followed by a painful rash that spreads and blisters, eventually causing the top layer of the skin to die and shed. This condition is often triggered by certain medications and can affect the eyes, mouth, and genitals as well.
Stevens–Johnson syndrome: Stevens–Johnson syndrome (SJS) is a severe skin and mucous membrane reaction, often triggered by medications. It involves painful blistering and can be life-threatening.
Tendon Rupture: A tendon rupture is a complete or partial tear in the tough, fibrous connective tissue that attaches muscle to bone. This injury can occur due to sudden, forceful movements or chronic degeneration, and it often results in pain, swelling, and impaired mobility in the affected area.
Trimethoprim and sulfamethoxazole: Trimethoprim and sulfamethoxazole is a combination antibiotic used to treat various bacterial infections, including those of the urinary tract. It works by inhibiting the production of folic acid in bacteria, which is essential for their growth and replication.
Trimethoprim and sulfamethoxazole (TMP/SMX): Trimethoprim and sulfamethoxazole (TMP/SMX) is a combination antibiotic used to treat various bacterial infections, including urinary tract infections (UTIs). It works by inhibiting two sequential steps in the bacterial folate synthesis pathway, making it highly effective against a broad spectrum of bacteria.
Trimethoprim-Sulfamethoxazole: Trimethoprim-sulfamethoxazole is a combination antibiotic medication used to treat a variety of bacterial infections, including those affecting the urinary tract. It works by inhibiting the synthesis of essential bacterial proteins, effectively preventing the growth and replication of the targeted pathogens.
Ureters: The ureters are a pair of muscular tubes that connect the kidneys to the bladder. They are responsible for transporting urine from the kidneys to the bladder for storage and eventual elimination from the body.
Urethra: The urethra is a tube that carries urine from the bladder out of the body. It is an essential part of both the urinary and reproductive systems, playing a crucial role in eliminating waste and facilitating sexual function.
Urinalysis: Urinalysis is the physical, chemical, and microscopic examination of urine, which provides valuable information about a person's overall health and can help diagnose various medical conditions. It is an important diagnostic tool in the context of both diuretics and urinary anti-infectives.
Urinary anti-infectives: Urinary anti-infectives are medications specifically used to treat and prevent infections in the urinary tract. They work by eliminating or inhibiting the growth of bacteria that cause urinary tract infections (UTIs).
Urinary Tract Infections: Urinary tract infections (UTIs) are bacterial infections that can occur anywhere along the urinary tract, including the bladder, kidneys, ureters, and urethra. They are a common health issue that can significantly impact an individual's well-being and require appropriate treatment and management.
Urine Culture: A urine culture is a laboratory test that analyzes a sample of urine to identify the presence and type of bacteria or other microorganisms that may be causing a urinary tract infection (UTI). It is an important diagnostic tool used in the context of urinary anti-infectives, as it helps guide appropriate antibiotic treatment.
Uropathogens: Uropathogens are microorganisms, primarily bacteria, that can infect the urinary tract and cause urinary tract infections (UTIs). These pathogens have the ability to colonize and proliferate within the urinary system, leading to various types of urinary tract infections.