Please respond to this classmates post with a minimum of two paragraphs, cited and app style. Two references no more than 5yrs old.
Post: Urinary tract infections (UTIs) are among the most common infectious diseases occurring in either the community or healthcare setting. Uncomplicated UTIs typically occur in the healthy adult non-pregnant woman, while complicated UTIs (cUTIs) may occur in all sexes and age groups and are frequently associated with either structural or functional urinary tract abnormalities. Examples include foreign bodies such as calculi (stones), indwelling catheters or other drainage devices, obstruction, immunosuppression, renal failure, renal transplantation and pregnancy. UTI in the elderly is almost always complicated in men with prostatic hypertrophy and in post-menopausal women who may have an increased post-void residual volume.
A urinary tract infection is an infection anywhere in the urinary tract. These often cause inflammation of the urethra (urethritis), bladder (cystitis), or kidneys (pyelonephritis).The symptoms depend on the area affected. Typical symptoms of a lower UTI include frequency and dysuria without fever, chills or back pain whereas upper UTI usually presents with symptoms of pyelonephritis such as loin pain, flank tenderness, fever or other signs of a systemic inflammatory response.
Urinary tract infection is diagnosed by examination of a urine culture. Further investigations using intravenous urography or ultrasound scanning may be necessary. Most urinary tract infections are treated with antibiotic drugs. Increasing fluid intake and taking preparations such as potassium citrate that make the urine less acidic can relieve the symptoms.
Trimethoprim/ sulfamethoxazole (Bactrim)
Antibiotics—trimethoprim/ sulfamethoxazole (Bactrim) remains the first choice for community-acquired UTI in most areas. Complicated UTI is caused by a wider spectrum of organisms, and recommendations for treatment differ. Guidelines on specific antibiotic treatment and duration of treatment are available, but with increasing antibiotic resistance (including of E. coli to Trimethoprim), local microbiological advice should be taken into account when choosing antibiotic treatment.
Advantages: Cheap, Well tolerated, high concentrations in vaginal and peri-urethral fluid. Possible reduced risk of emergence of resistant strains.
Disadvantages: Increasing rates of resistance, adverse reactions (e.g. rash) to sulphonamide component.
The efficacy of antibiotics is not fully predictable from in vitro sensitivity testing, which is probably part of the reason why trimethoprim (with or without sulphamethoxazole) remains the first-line choice in many areas, despite an upward trend in resistance rates.
References:
Scottish Intercollegiate Guidelines Network (2016). SIGN 88: Management of suspected bacterial urinary tract infections in adults.
Dai B, et al. (2013). Long-term antibiotics for the prevention of recurrent urinary tract infection in children: a systematic review and meta-analysis. Arch Dis Child, 95, 499–508.
Wagenlehner FM, Naber KG, (2016). Treatment of bacterial urinary tract infections: presence and future. Eur Urol, 49, 235–44.[CrossRef] [Web of Science] [Medline]
