Antibacterial therapy for urinary tract infection

One of the most common reasons for visiting a urologist today are genitourinary infections (URIs), which should not be confused with STIs. The latter are sexually transmitted, while MPI are diagnosed at any age and occur for other reasons.

Bacterial damage to the organs of the excretory system is accompanied by severe discomfort - pain, burning, frequent urge to empty the bladder, the release of a pathological secret from the urethra. In severe infections, intense febrile and intoxication symptoms may develop.

The best treatment option is the use of modern antibiotics, which allow you to get rid of the pathology quickly and without complications.

Genitourinary infections include several types of inflammatory processes in the urinary system, which includes the kidneys with ureters (they form the upper sections of the urinary tract), as well as the bladder and urethra (lower sections):

- inflammation of the parenchyma and pyelocaliceal system of the kidneys, accompanied by pain in the lower back of varying intensity, as well as severe intoxication and feverish symptoms (lethargy, weakness, nausea, chills, muscle and joint pain, etc.).
- an inflammatory process in the bladder, the symptoms of which are frequent urge to urinate with an accompanying feeling of incomplete emptying, sharp pains, sometimes blood in the urine.
Urethritis is a lesion of the urethra (the so-called urethra) by pathogens, in which purulent discharge appears in the urine, and urination becomes painful. There is also a constant burning sensation in the urethra, dryness and cramps.

There can be several reasons for urinary tract infections. In addition to mechanical damage, pathology occurs against the background of hypothermia and a decrease in immunity, when conditionally pathogenic microflora is activated. In addition, infection often occurs due to poor personal hygiene, when bacteria enter the urethra from the perineum. Women get sick much more often than men at almost any age (with the exception of the elderly).

Antibiotics in the treatment of MPI

In the vast majority of cases, the infection is bacterial in nature. The most common pathogen is a representative of enterobacteria - Escherichia coli, which is detected in 95% of patients. Less common are S.saprophyticus, Proteus, Klebsiella, entero- and.

Also often the disease is caused by mixed flora (association of several bacterial pathogens).

Thus, even before laboratory tests, the best option for infections of the genitourinary system will be treatment with broad-spectrum antibiotics.

Modern antibacterial drugs are divided into several groups, each of which has a specific mechanism of bactericidal or bacteriostatic action. Some drugs are characterized by a narrow spectrum of antimicrobial activity, that is, they have a detrimental effect on a limited number of varieties of bacteria, while others (broad spectrum) are designed to combat different types of pathogens. It is the antibiotics of the second group that are used to treat urinary tract infections.

Penicillins

The first ABPs discovered by man were almost universal means of antibiotic therapy for quite a long time. However, over time, pathogenic microorganisms mutated and created specific defense systems, which required the improvement of medications.

At the moment, natural penicillins have practically lost their clinical significance, and instead of them, semi-synthetic, combined and inhibitor-protected antibiotics of the penicillin series are used.

Genitourinary infections are treated with the following drugs of this series:

. Semi-synthetic drug for oral and parenteral use, acting bactericidal by blocking the biosynthesis of the cell wall. It is characterized by rather high bioavailability and low toxicity. It is especially active against Proteus, Klebsiella and Escherichia coli. In order to increase resistance to beta-lactamases, the combined agent Ampicillin / Sulbactam ® is also prescribed.
. In terms of the spectrum of antimicrobial action and effectiveness, it is similar to the previous ABP, but it is distinguished by increased acid resistance (it does not break down in an acidic gastric environment). Its analogues and are also used, as well as combined antibiotics for the treatment of the genitourinary system (with clavulanic acid) - Amoxicillin / Clavulanate ® , ® ,.

Recent studies have revealed a high level of resistance of uropathogens to ampicillin and its analogues.

For example, the sensitivity of Escherichia coli is slightly more than 60%, which indicates the low effectiveness of antibiotic therapy and the need to use other groups of antibiotics. For the same reason, the antibiotic sulfanilamide () is practically not used in urological practice.

Recent studies have revealed a high level of resistance of uropathogens to ampicillin ® and its analogues.

Cephalosporins

Another group of beta-lactams with a similar effect, differing from penicillins in increased resistance to the destructive effects of enzymes produced by pathogenic flora. There are several generations of these medications, and most of them are intended for parenteral administration. From this series, the following antibiotics are used to treat the genitourinary system in men and women:

. An effective medicine for inflammation of all organs of the urogenital area for oral administration with a minimum list of contraindications.
(Ceclor ® , Alfacet ® , Taracef ®). It belongs to the second generation of cephalosporins and is also used orally.
and its analogues Zinacef ® and. Available in several dosage forms. They can be prescribed even to children of the first months of life due to low toxicity.
. Sold in the form of a powder for the preparation of a solution, which is administered parenterally. Substitutes are also Rocephin ® .
(Cefobid ®). A representative of the third generation of cephalosporins, which is administered intravenously or intramuscularly for genitourinary infections.
(Maxipim ®). The fourth generation of antibiotics of this group for parenteral use.

These drugs are widely used in urology, but some of them are contraindicated for pregnant and lactating women.

Fluoroquinolones

The most effective antibiotics to date for genitourinary infections in men and women. These are powerful synthetic drugs of bactericidal action (death of microorganisms occurs due to disruption of DNA synthesis and destruction of the cell wall). They are highly toxic antibacterial agents. They are poorly tolerated by patients and often cause undesirable effects from ongoing therapy.

Contraindicated in patients with individual intolerance to fluoroquinolones, patients with CNS pathologies, epilepsy, persons with kidney and liver pathologies, pregnant women, breastfeeding, and patients under 18 years of age.

. Taken orally or parenterally, it is well absorbed and quickly eliminates painful symptoms. It has several analogues, including Tsiprinol ® .
( , Tarivid ®). The antibiotic fluoroquinolone is widely used not only in urological practice due to its effectiveness and wide spectrum of antimicrobial activity.
(). Another drug for oral, as well as intravenous and intramuscular use. It has the same indications and contraindications.
Pefloxacin ® (). Also effective against most aerobic pathogens, taken parenterally and orally.

These antibiotics are also shown in mycoplasma, since they act on intracellular microorganisms better than the previously widely used tetracyclines. A characteristic feature of fluoroquinolones is a negative effect on connective tissue. It is for this reason that drugs are forbidden to be used before reaching the age of 18, during periods of pregnancy and breastfeeding, as well as to persons diagnosed with tendonitis.

Aminoglycosides

A class of antibacterial agents intended for parenteral administration. The bactericidal effect is achieved by inhibiting the synthesis of proteins, mainly gram-negative anaerobes. At the same time, the drugs of this group are characterized by rather high rates of nephro- and ototoxicity, which limits the scope of their application.

. A drug of the second generation of aminoglycoside antibiotics, which is poorly adsorbed in the gastrointestinal tract and therefore is administered intravenously and intramuscularly.
Netilmecin ® (Netromycin ®). Belongs to the same generation, has a similar effect and a list of contraindications.
. Another aminoglycoside, effective for urinary tract infections, especially complicated ones.

Due to the long half-life, these drugs are used only once a day. They are prescribed for children from an early age, but lactating women and pregnant women are contraindicated. Antibiotics-aminoglycosides of the first generation in the treatment of urinary tract infections are no longer used.

Nitrofurans

Broad-spectrum antibiotics for infections of the genitourinary system with a bacteriostatic effect, which manifests itself in relation to both gram-positive and gram-negative microflora. At the same time, resistance in pathogens is practically not formed.

These drugs are intended for oral use, and food only increases their bioavailability. For the treatment of urinary tract infections, Nitrofurantoin ® (trade name Furadonin ®) is used, which can be given to children from the second month of life, but not to pregnant and lactating women.

The antibiotic trometamol, which does not belong to any of the above groups, deserves a separate description. It is sold in pharmacies under the trade name Monural and is considered a universal antibiotic for inflammation of the genitourinary system in women.

This bactericidal agent for uncomplicated forms of inflammation of the urinary tract is prescribed as a one-day course - 3 grams of fosfomycin ® once (according to indications - twice). Approved for use at any stage of pregnancy, practically does not give side effects, can be used in pediatrics (from 5 years old).

cystitis and urethritis

As a rule, cystitis and a nonspecific inflammatory process in the urethra occur simultaneously, so there is no difference in their antibiotic therapy. In uncomplicated forms of infection, the drug of choice is.

Also, for uncomplicated infections in adults, a 5-7 day course of fluoroquinolones (Ofloxacin ® , Norfloxacin ® and others) is often prescribed. Reserves are Amoxicillin/Clavulanate ® , Furadonin ® or Monural ® . Complicated forms are treated similarly, but the course of antibiotic therapy lasts at least 1-2 weeks.

For pregnant women, Monural ® is the drug of choice; beta-lactams (penicillins and cephalosporins) can be used as an alternative. Children are prescribed a seven-day course of oral cephalosporins or Amoxicillin ® with potassium clavulanate.

Additional Information

It should be borne in mind that complications and a severe course of the disease require mandatory hospitalization and treatment with parenteral drugs. Oral medications are usually prescribed on an outpatient basis. As for folk remedies, they do not have a special therapeutic effect and cannot be a substitute for antibiotic therapy. The use of infusions and decoctions of herbs is permissible only by agreement with the doctor as an additional treatment.

Urinary tract infection (UTI) is a polyetiological disease associated with various factors. A key role in its development belongs to microorganisms (especially E. coli). In this case, the kidneys and bladder are more affected, leading to pathologies such as cystitis and pyelonephritis. Diseases can acquire acute and chronic course. In adult men, such pathologies occur against the background of various sexually transmitted infections.

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Types of diseases
Urinary tract infections (UTIs) are caused to a greater extent by gram-negative microflora, in 80% of cases E. coli becomes the cause. In men, this group of diseases is much less common than in women, which is associated with the anatomical features of the structure.
Pathogens can affect the following organs:
- The urethra with the development of a disease such as urethritis.
- Bladder - cystitis.
- The prostate gland is prostatitis.
- Kidneys - pyelonephritis or glomerulonephritis.
These diseases most often occur in an acute form, especially if their cause is Escherichia coli. When infected with other pathogens, the tendency to chronicity is much higher. With chlamydia, mycoplasmosis, gonorrhea infection, the initial symptoms can be very mild, so patients rarely go to the doctor, which is why the disease takes a chronic course, leading to serious complications from both the urinary and reproductive systems of men.
Depending on the pathogen, specific and nonspecific lesions are distinguished. In the first case, various venereal diseases become the cause, in the second - opportunistic microorganisms (E. coli).
The mechanism of the occurrence of pathology
The entry and spread of infection in the urinary tract occurs in several ways. The most common is the transition of bacteria from the anus to the nearby urethra. Already at this stage, a man can develop urethritis and prostatitis.
In the future, along the wall of the urethra, the infection enters the bladder, causing its inflammation - cystitis.
The mucosa of the genitourinary system contains special defense mechanisms against bacteria, so pathology does not always occur. The infection can transit several departments at once and not lead to illness. The last point is the kidneys, where it can cause a variety of diseases, the most common of which is pyelonephritis.
Another way of getting the infection is to bring it from other foci into the urinary system through the blood or lymph. This method is more typical for a disease such as glomerulonephritis.
The reasons
The entry of the pathogen into the body is not a prerequisite for the onset of the disease: for this to happen, some predisposing factors must be present:
- Decreased immune system due to various acute and chronic diseases.
- Urolithiasis, which is often accompanied by infections of the urinary system.
- Frequent hypothermia (the seasonality of the pathology is associated with this - the cold season).
- Violation of the outflow of urine in benign hyperplasia and inflammation of the prostate gland.
- Chaotic sex life.
- The use of various drugs, especially antibiotics.
In children, urinary tract infection may occur as a result of congenital malformations associated with a violation of the nervous regulation of motility. This leads to the formation of reflux and stagnation of urine.
Dr. Komarovsky singles out the main reason for the appearance of UTIs in infants is hypothermia associated with prolonged wearing of diapers. Children of the first year of life are more prone to various diseases, as the immune system is poorly developed. The baby in the first months uses the protection of the mother, received with milk.
In preschool children, inflammation occurs after playing in the sandbox, since there are a large number of bacteria in this place, and they are in direct contact with infected sand. Girls are especially affected by this.
Manifestations of urethritis
The main signs of urethritis are urination disorders. Urine excretion is accompanied by subjective sensations in the form of:
- burning sensation;
- itching;
- pain;
- frequent urge to urinate.
Various discharges appear - serous, purulent, mucous. Symptoms will also vary depending on the pathogen. With urethritis caused by opportunistic flora, the manifestations will be pronounced, the discharge will be purulent or mucous. Burning and itching intense.

Specific infections used to also have characteristic and typical signs. To date, all practicing physicians note that diseases such as mycoplasmosis, gonorrhea, chlamydia are sluggish and have poor symptoms. This makes diagnosis very difficult. In such situations, patients may be disturbed by whitish discharge, migratory urination disorders. Burning, itching and pain are mild.
Symptoms of cystitis
Inflammation of the bladder in men appears much less frequently than in women, but they have a higher tendency to chronicize the process.
The disease begins suddenly - with frequent and painful urge to urinate. Urine is excreted in small portions, there is a feeling of incomplete emptying of the bladder. There is pain in the suprapubic region, body temperature may rise to +37 ... +38 degrees.
Inflammation of the bladder - wall changes
Frequent urination is observed at night. Urine becomes cloudy, microscopic examination may show the content of blood cells.
In the chronic course of the disease, UTI is manifested by periods of exacerbation and remission. Patients are concerned about minor cramps and pain during urination, the temperature does not exceed +37 degrees or does not rise at all.
Signs of pyelonephritis
The acute course of pyelonephritis is characterized by a sharp increase in body temperature to +38 ... +39 degrees, but there are cases without hyperthermia. There is a pulling dull pain in the lumbar region.
The urine becomes cloudy, the protein content increases, the number of leukocytes increases, hematuria (blood in the urine) is observed. In the clinical analysis of blood, the erythrocyte sedimentation rate increases and neutrophilic leukocytosis is noted.
Urination is disturbed, frequent urges appear that become painful, urine is excreted in small portions due to spasm of the urinary tract.
The inflammatory process leads to intoxication, resulting in severe headache, severe weakness, vomiting, diarrhea may occur.
Kidney with pyelonephritis
You can check for yourself the presence of pyelonephritis by slightly tapping on the lower back (Pasternatsky's symptom), after which the pain increases.
The chronic course of the disease may not manifest outwardly, sometimes there may be mild back pain. In the clinical analysis of urine, similar changes are observed, expressed to a lesser extent. Ultrasound examination shows violations of the pyelocaliceal system, which increase over time.
Treatment
The mainstay of treatment for urinary tract infections is the appointment of antibacterial agents. Thus, there is an impact on the etiological factor and the complete elimination of the disease. The following groups of antibiotics are used:
- With urethritis, Ceftriaxone is prescribed intramuscularly or intravenously. They can also use Doxycycline, Azithromycin in the form of tablets or injections.
- With an uncomplicated course of cystitis, nitrofuran preparations are prescribed - Furagin, Furomag. You can use 3 g of Fosfomycin once. Azithromycin, Nitroxoline are also prescribed.
- With pyelonephritis, antibiotics are mandatory intravenously or intramuscularly - Ciprofloxacin, Levofloxacin, Ceftriaxone.
In the case of an acute process, drugs are prescribed empirically, broad-spectrum drugs are used to capture the maximum number of microorganisms. It is ideal to carry out bacteriological culture before antibacterial treatment, after which, taking into account the sensitivity of the pathogen, certain medications are prescribed.
The patient's condition threatens with serious complications, so antibiotics are first prescribed depending on the clinical manifestations. After receiving the result of a laboratory study, the therapy is adjusted.
Detoxification
With severe intoxication, it is necessary to prescribe solutions for intravenous administration in order to purify the blood from the products of the inflammatory reaction:
- Reasorbilact.
- Reopoliglyukin.
- Saline.
- glucose solution.
- Poliglukin.
Such therapy is more often used for pyelonephritis, since this disease gives a strong release of toxic substances into the blood.
Symptomatic therapy
To eliminate pain phenomena, painkillers are prescribed - Analgin, Dexalgin. Urination disorders in the form of frequent urges are removed by using antispasmodics - No-Shpa, Baralgin, Spazmalgin.
At high temperatures, antipyretic drugs are used - Nimesil, Ibuprofen, acetylsalicylic acid.
In parallel with antibiotic therapy, agents from the group of probiotics are prescribed to normalize bowel activity.
Phytotherapy
Urinary tract infectionstreated by the use of folk remedies. To do this, use herbs and fees from medicinal plants. The following are the most effective:
- Horsetail herb - has antispasmodic, diuretic, antibacterial and anti-inflammatory effects. Indicated for all types of UTI.
- Bearberry leaf is a strong remedy for inflammatory processes in the urinary tract. Relieves inflammation, spasm and reduces dysuria.
- Birch buds - have an antibacterial and antispasmodic effect.
- Parsley and fennel seeds - have antispasmodic and anti-inflammatory effects.
These medicinal plants are used both independently and in the form of a collection. An infusion is prepared at home: 1 tbsp. l. herbs or mixtures. It is better to do this in a water bath. For bearberry, the cooking time is 30 minutes, for other plants - 15.
The resulting solution is filtered and consumed 1/3 cup 3 times.
Pharmacy phytopreparations
From ready-made medicines in a pharmacy, you can purchase drugs such as Urolesan, Canephron, Trinephron, Uroton, etc.
Urolesan is available in capsules and tablets. It contains a complex of essential oils and an extract from plants that have diuretic, antispasmodic, anti-inflammatory and antibacterial effects. Use 20 drops for sugar 3 times a day or 1 capsule three times a day.
Kanefron is used in inflammatory processes of the urinary tract. It has the same indications as Urolesan. The drug is most widely used in acute and chronic cystitis.
These drugs are prescribed by doctors for UTI, as they significantly improve the effect of the main therapy and reduce the risk of complications.

Pyelonephritis, cystitis and other diseases of the urination system require complex therapy. Antibiotics are an effective remedy for infections of the genitourinary system, but they should be used only as directed by a doctor. Only by passing tests can you determine the pathogen that led to the disease and determine an effective medicine.

If you have a urinary tract infection, you may need to take several types of medications for a full recovery.

Indications for treatment

The genitourinary system and kidneys during inflammation and infection with harmful bacteria are determined by specific symptoms. Diseases are accompanied by pain, burning and frequent urination. The patient, when diagnosing genitourinary infections, cannot have a normal sexual life. Without the use of properly selected drugs, inflammation of the urinary tract leads to complications. Drug therapy is prescribed for such diseases:

pyelonephritis;
cystitis;
urethritis in men;
vaginitis in women;
chlamydia.

Some types of pathogenic microorganisms are sexually transmitted. Timely diagnosis will help to avoid negative consequences.

Types of drugs for the genitourinary system

In kidney diseases, taking into account the etiology of the disease, various groups of drugs are used to combat pathologies. Depending on the active substances that make up the drugs, they affect the body in different ways. The main types of medicines that are used to treat infections of the genitourinary system:

Antibiotics, uroseptics, NSAIDs, immunomodulators and other medicines are taken from urinary tract infections.

NSAIDs;
uroseptics;
drugs for symptomatic treatment;
immunomodulators.

Antibiotics

And urinary tract infections are prescribed depending on the pathogen. But it takes time to determine it, therefore, as a rule, therapy begins with broad-spectrum antibiotics. Treatment with such drugs helps to get rid of the problem in a short time, but requires an integrated approach. After a course of taking such funds, attention should be paid to the restoration of beneficial microflora.

Drug groups

To cure inflammation of the genitourinary system, the following types of antibacterial agents are used:

Nitrofuran drugs - prescribed to fight infection in the elderly. Do not use in renal failure.
Cephalosporins - effectively destroy almost all types of pathogenic microorganisms of the genitourinary system.
Macrolides have immunomodulatory and anti-inflammatory effects. But they are used only as directed by a doctor.
Sulfonamides - successfully fight bacterial inflammation. Do not use for kidney problems.
Antibacterial agents based on pipemidic acid are used to fight infection in men caused by prostate adenoma.

Anti-inflammatory drugs

Anti-inflammatory drugs for urinary tract infections can quickly eliminate the pathogenic microflora.

A group of drugs that can quickly relieve pain and inflammation of the bladder. Contribute to the restoration of normal blood circulation and the cessation of spasms. Means based on "Ibuprofen" quickly help to return to a normal way of life, alleviate the symptoms of the disease. When diagnosing gastrointestinal problems, do not use pills. An anti-inflammatory agent is administered intramuscularly or rectal suppositories are used to prevent stomach disorders.

uroseptics

Medicines of this group have antimicrobial and antiseptic effects. They are based on herbs and, as a rule, are used for the prevention of diseases in people with chronic infectious diseases of the urinary system. The action of the funds is aimed at improving the functions of the genitourinary organs, disinfect urine and promote the elimination of harmful substances in a natural way.

Symptomatic drugs

A urinary tract infection is accompanied by the following symptoms:

pain in the lower back or in the suprapubic area;
burning when urinating;
frequent urge to go to the toilet, every 10-15 minutes;
the appearance in the urine of pus, blood or mucus;
temperature rise.

To get rid of these symptoms in inflammation of the kidneys, doctors prescribe symptomatic therapy with antispasmodics, diuretics or analgesics. The former prevent urinary retention and relieve pain. Diuretics increase the amount of urine. In turn, painkillers should not be nephrotoxic. Otherwise, acute renal failure develops. In addition, while taking a course of antibiotics, it would be useful to use prebiotic preparations to restore the functioning of the gastrointestinal tract and restore beneficial microflora.

With infections that enter the body sexually (see about sexual infections), both the reproductive and urinary organs are simultaneously affected, since they are functionally related. A course of antibiotics, which is mandatory in such cases, can be carried out both in a hospital and at home.

Features of antibiotic therapy

The main goal of antibiotic treatment is the destruction of certain pathogens identified during the diagnosis.

After such diagnostic studies as polymerase chain reaction, bacteriological seeding, DNA and antigens to a pathogenic bacterium are detected. During examinations, the sensitivity of the pathogen to various antibacterial drugs is also recognized, which determines the course of treatment.

Antibiotic therapy makes sense in inflammatory processes characterized by urination disorders, purulent discharge, reddening of the mucous tissues of the genitals. Their use contributes to the removal of inflammation, pain syndrome and prevents further spread of infection to nearby organs and body systems. A tangible and fairly quick result of antibiotic therapy depends on the early treatment of the patient, when the disease is at an early stage.

Types of antibiotics and their main properties

Antibacterial agents are substances that are used to slow down the growth and reproduction of pathogenic microorganisms, to destroy them. They can be organic, that is, produced on the basis of bacteria, but at the same time, they are fatal for pathogenic viruses. Today, there are also combined and synthetic drugs.

These medicines are classified:

by type of exposure and chemical composition;
on the spectrum of action (narrow and wide).

Bactericidal drugs cause disturbances in the vital activity of the pathogen, leading to its death. Bacteriostatic - slow down growth processes, reduce viability, stop the impact of pathogenic organisms on the body.

There are several main types of antibiotics:

Penicillins (a class of beta-lactam drugs)

Properties- a pronounced bactericidal effect, consisting in the suppression of the synthesis of the cell wall of the microbe, leading to its death. The chemical composition of this group is active against gram-positive and gram-negative bacteria - enterococci, spirochetes, nesseria, actinomycetes, most corynebacteria.

Preparations- Penicillin, Benzylpenicillin, Phenoxymethylpenicillin, from broad-spectrum formulations - Ampicillin, Hiconcil, Flemoxin Solutab. Means with prolonged action - Extencillin, Bicillin, Retarpen. Of the semi-synthetics - Oxacillin, active against staphylococci.

In the treatment of urogenital inflammatory processes, antipseudomonal penicillins are often used - Pipracil, Carbenicillin, Securopen.