Urinary tract infections are bacterial infections targeting the urinary tract. They affect over 150 million people in the world each year, including children. The main symptoms indicating the presence of a UTI include changes in frequency and urgency of urination, burning on urination, urinary incontinence, and dysuria. In infants, UTIs can be associated with fever, while children often experience abdominal pain as a result of a UTI.
Treatment of UTI
The main line of treatment for UTI is the use of antibiotics. However, if the patient’s symptoms are severe, the treatment plan can also include the use of topical analgesics, such as phenazopyridine. This drug can help to relieve burning and inflammation associated with a UTI. The choice of preferred treatment thus depends on the type of UTI (complicated or uncomplicated), the results of culture and sensitivity tests, as well as the severity of the symptoms. In addition, it is essential to take into account the patient’s age and whether or not the patient is pregnant.
Trimethoprim and Sulfamethoxazole
Woo and Robinson (2015) recommend using trimethoprim and sulfamethoxazole as a first-line treatment for UTIs. Both of these components are antibiotics, and combination therapy using these two drugs increases the effectiveness of the treatment while also reducing the risk of resistance and treatment time. Trimethoprim and sulfamethoxazole wok by inhibiting DNA synthesis in bacteria, thus preventing bacterial growth and eliminating the infection. The recommended treatment for adults includes 1 double-strength tablet twice daily for 3 days. For children, 3-6 mg trimethoprim and 15 to 30 mg of sulfamethoxazole per kg should be administered twice daily for 10 days.
Woo and Robinson (2015) recommend using nitrofurantoin as the first-line treatment of uncomplicated lower UTI in adult women, as it has a low resistance rate among E. coli bacteria. Nitrofurantoin inhibits the enzymes involved in the synthesis of DNA and RNA in bacteria, preventing replication. The recommended treatment for adults includes nitrofurantoin 100 mg twice daily for 5-7 days, whereas children should receive a daily dose of 5-7 mg per kilogram of body weight (divided into four daily doses) for 7 to 7 days.
Fluoroquinolones are also a class of antibiotics, which includes ciprofloxacin and levofloxacin, used for UTI treatment. However, due to high rates of resistance, these drugs should not be used as first-line therapy of UTIs. Nevertheless, if supported by the results of culture and sensitivity tests, fluoroquinolones can be used to treat UTIs in adults. Furthermore, ciprofloxacin can be prescribed to children and pregnant women. Fluoroquinolones work by inhibiting bacterial DNA gyrase and topoisomerase IV. This prevents chromosomal supercoiling in bacteria, impairing replication and growth. This class of medications should not be prescribed to patients at risk for or diagnosed with tendon disorders. In other adults, 250-500 mg once or twice a day for 3 or 14 days is appropriate.
Cephalosporins are used as a first-line treatment for pregnant women and for patients allergic to sulfa drugs. However, they should not be chosen as a first-line treatment for other patient groups, as they have a high risk of allergic reactions and can have a negative effect on bowel flora. Therefore, these drugs can lead to gastrointestinal side effects, including nausea and diarrhea. Cephalosporins inhibit the formation of cell walls in bacteria by disrupting the activity of penicillin-binding proteins. Adults should be treated with 200 mg of cephalosporins twice daily for 14 days, whereas children should receive 25-50 mg per kilogram of weight daily, divided into 3-4 doses.
Penicillins are not recommended as a first-line treatment due to a high risk of allergies and high rates of resistance. However, amoxicillin can be prescribed for the treatment of UTIs in pregnant women and children. In treating UTIs in non-pregnant adults, 500 mg should be taken twice daily for 14 days. Pregnant women should receive a prescription for 500 mg of amoxicillin three times daily for 7 days. Children should be prescribed 40 mg per kilogram, divided into 2-3 daily doses, for 10 days.
Phenazopyridine is not an antibiotic, but an azo dye that has a topical analgesic effect on the mucosa of the urinary tract. It can be prescribed to patients with severe symptoms or pain, as it relieves pain and burning on urination. Adults can take 200 mg of phenazopyridine three times daily for 2-3 days along with the chosen antibiotic treatment.
Effects of Antibiotic Therapy of UTIs
An appropriate antibiotic therapy helps to reduce the symptoms of the UTI, decrease bacteria content in culture tests, and reduce the risk of recurrent UTIs. However, antibiotics can also have various side effects, including gastrointestinal (nausea, diarrhea, loss of appetite) and neurological symptoms (dizziness, confusion, tremors), as well as skin rashes. Fluoroquinolones can also cause joint disorders and increased intracranial pressure.
Conclusion: Nursing Implications
Therefore, in considering treatment options for patients, nurses should look for evidence of effectiveness, as well as the low frequency of side effects.
Preferred pharmacological therapy of a UTI should thus be effective in reducing symptoms and eradicating the infection, have few side effects, and be suitable for the patient’s age and condition. As a result, such treatment can have a positive effect on patients’ quality of life and on reducing the burden of UTI.