Preparations for the treatment of the urinary tract in women. Tablets for the treatment of the genitourinary system in women. Combined antibacterial agents

Urinary tract infections (UTIs) are a group of diseases of the organs of urination and urinary excretion that develop as a result of infection of the genitourinary tract by pathogenic microorganisms. With UTI, bacteriological examination in 1 ml of urine reveals at least one hundred thousand colony-forming microbial units. In women and girls, the disease occurs ten times more often than in men and boys. In Russia, UTI is considered the most common infection.

1. Depending on which part of the urinary tract affects infectious agents, the following types of UTIs are distinguished:

• upper urinary tract infection- this is pyelonephritis, in which the kidney tissue and the pyelocaliceal system suffer;
• lower urinary tract infection- these are cystitis, urethritis and prostatitis (in men), in which the inflammatory process develops in the bladder, ureters or prostate gland, respectively.

1. Depending on the origin of the infection in the urinary system, there are several types of it:

• uncomplicated and complicated. In the first case, there is no violation of the outflow of urine, that is, there are neither anomalies in the development of the urinary organs, nor functional disorders. In the second case, there are developmental anomalies or dysfunctions of organs;
• hospital and outpatient. In the first case, the causes of infection are diagnostic and therapeutic manipulations performed on the patient. In the second case, the inflammatory process is not associated with medical interventions.

1. According to the presence of clinical symptoms, the following types of the disease are distinguished:

• clinically expressed infections;
• asymptomatic bacteriuria.

Urinary tract infections in children, pregnant women and men in most cases are complicated and difficult to treat. In these cases, there is always a high risk of not only recurrence of the infection, but also the development of sepsis or kidney abscess. Such patients undergo an extended examination in order to identify and eliminate the complicating factor.

FACTORS CONTRIBUTING TO THE DEVELOPMENT OF UTI:

• congenital anomalies in the development of the genitourinary system;
• functional disorders (vesicoureteral reflux, urinary incontinence, etc.);
• concomitant diseases and pathological conditions (urolithiasis, diabetes mellitus, renal failure, nephroptosis, multiple sclerosis, kidney cyst, immunodeficiency, spinal cord lesions, etc.);

• sexual life, gynecological operations;
• pregnancy;
• advanced age;
• foreign bodies in the urinary tract (drainage, catheter, stent, etc.).

Elderly people is a separate risk group. Infection of the genitourinary tract in them is promoted by the insolvency of the epithelium, the weakening of general and local immunity, the decrease in secretion of mucus by the cells of the mucous membranes, and microcirculation disorders.

urinary tract infections in women develop 30 times more often than in men. This happens due to some features of the structure and functioning of the female body. The wide and short urethra is located in close proximity to the vagina, which makes it accessible to pathogens in case of inflammation of the vulva or vagina. There is a high risk of developing urinary tract infections in women with cystocele, diabetes, hormonal and neurological disorders. The risk group for the development of UTIs includes all women during pregnancy, women who have an early sexual life and have had several abortions. Non-compliance with personal hygiene is also a factor contributing to the development of inflammation of the urinary tract.

As women age, the incidence of UTIs increases. The disease is diagnosed in 1% of girls of school age, in 20% of women aged 25–30 years. The incidence reaches its peak in women over 60 years of age.

In the vast majority of cases, urinary tract infections in women recur. If the symptoms of UTI reappear within a month after recovery, this indicates a lack of therapy. If the infection returns after a month after treatment, but no later than six months, it is considered that a re-infection has occurred.

UTI CAUSES AND WAYS OF THEIR PENETRATION INTO THE BODY

In the etiology of all types of UTIs, Escherichia coli plays a major role. The causative agents of the disease can be Klebsiella, Proteus, Pseudomonas aeruginosa, Enterococcus, Streptococcus, fungi of the genus Candida. Sometimes the infectious process is caused by mycoplasmas, chlamydia, staphylococci, Haemophilus influenzae, corynebacteria.

The etiological structure of UTI is different in women and men. In the former, Escherichia coli dominates, while in the latter, the disease is more often caused by Pseudomonas aeruginosa and Proteus. Hospital UTIs in outpatients are twice as likely to be caused by E. coli as compared to inpatients. With bacteriological in patients undergoing treatment in a hospital, Klebsiella, Pseudomonas aeruginosa, Proteus are more often sown.

To assess the results of a bacteriological study of urine, doctors use the following quantitative categories:

• up to 1000 CFU (colony-forming units) in 1 ml of urine - natural infection of urine when it passes through the urethra;
• from 1000 to 100,000 CFU / ml - the result is doubtful, and the study is repeated;
• 100,000 or more CFU / ml - an infectious process.

Routes of entry of pathogens into the urinary tract:

• urethral (ascending) path, when the infection from the urethra and bladder "rises" through the ureters to the kidneys;
• descending path, in which pathogenic microorganisms from the kidneys "go down";
• lymphogenous and hematogenous pathways, when pathogens enter the urinary organs from nearby pelvic organs with the flow of lymph and blood;
• through the wall of the bladder from adjacent foci of infection.

SYMPTOMS OF URINARY TRACT INFECTIONS

In newborns with urinary tract infection, the symptoms of the disease are nonspecific: vomiting, irritability, fever, poor appetite, low weight gain. If the baby has at least one of the listed symptoms, you should immediately consult a pediatrician.

Clinical picture of urinary tract infection in preschool children- these are most often dysuric disorders (pain and cramps during urination, frequent urination in small portions), irritability, apathy, and sometimes fever. The child may complain of weakness, chills, pain in the abdomen, in its lateral sections.

School children:

• In school-age girls with urinary tract infections, the symptoms of the disease in most cases are reduced to dysuric disorders.
• In boys under 10 years of age, body temperature often rises, and in boys of 10–14 years, urination disorders predominate.

Symptoms of UTIs in adults are increased frequency and impaired urination, fever, weakness, chills, pain above the pubis, often radiating to the lateral sections of the abdomen and to the lower back. Women often complain of vaginal discharge, men often complain of urethral discharge.

The clinical picture of pyelonephritis is characterized by pronounced symptoms: high body temperature, pain in the abdomen and in the lumbar region, weakness and fatigue, dysuric disorders.

DIAGNOSTICS OF URINARY TRACT INFECTIONS

To make a diagnosis, the doctor finds out the patient's complaints, asks him about the onset of the disease, about the presence of concomitant pathology. Then the doctor conducts a general examination of the patient and gives directions for examinations.

The main biological material for research in case of suspected UTI is urine collected in the middle of urination after a thorough toilet of the perineum and external genitalia. For bacteriological culture, urine should be collected in a sterile container. Clinical and biochemical analyzes of urine are carried out in the laboratory, material is sown on nutrient media to identify the causative agent of the infectious process.

Important:urine prepared for analysis must be quickly delivered to the laboratory, since every hour the number of bacteria in it doubles.

If necessary, the doctor prescribes ultrasound of the genitourinary tract, X-ray studies, CT, MRI, etc. And then, based on the results obtained, confirms or not the diagnosis of UTI, differentiating the level of damage and indicating the presence or absence of factors complicating the course of the disease.

A patient diagnosed with a urinary tract infection can receive treatment both on an outpatient basis and in a hospital. It all depends on the form and severity of the course of the disease, on the presence of complicating factors.

Important: any infectious process in the urinary organs should be treated by a doctor: therapist, pediatrician, nephrologist or urologist. Self-medication threatens the development of complications and relapses of the disease.

With urinary tract infections, treatment begins with regimen measures. These include limiting physical activity, frequent and regular (every two hours) urination, and drinking plenty of fluids to increase the amount of urine produced. In severe cases, patients are prescribed bed rest.

Smoked meats and marinades should be excluded from the diet, more foods containing ascorbic acid should be consumed. This is necessary to acidify the urine.

Of the drugs, antibiotics or sulfonamides are prescribed without fail, to which the infectious agent identified in the patient is sensitive. Comorbidities are being treated.

With a pronounced clinical picture of UTI, antispasmodics, antipyretics, antihistamines and painkillers are used. Phytotherapy and physiotherapy give a good effect. According to the indications, local anti-inflammatory treatment is carried out - installations of medicinal solutions through the urethra into the bladder.

PREVENTION OF URINARY TRACT INFECTIONS

Prevention of UTIs is as follows:

• timely detection and elimination of factors contributing to the development of infection in the urinary tract (anatomical abnormalities, inflammatory processes in the body, hormonal disorders, etc.);
• maintaining a healthy lifestyle and observing the rules of personal hygiene;
• treatment of existing diseases;
• for women - registration with a doctor for pregnancy at its earliest stages.

Zaluzhanskaya Elena Alexandrovna, medical observer

According to the localization of the infection, the urinary tract is divided into infections of the upper (pyelonephritis, abscess and carbuncle of the kidneys, apostematous pyelonephritis) and lower parts of the urinary tract (cystitis, urethritis, prostatitis).

According to the nature of the course of infection, UTIs are divided into uncomplicated and complicated . Uncomplicated infections occur in the absence of obstructive uropathy and structural changes in the kidneys and urinary tract, as well as in patients without serious concomitant diseases. Patients with uncomplicated urinary tract infections are more likely to be treated on an outpatient basis and do not require hospitalization. Complicated infections occur in patients with obstructive uropathy, against the background of instrumental (invasive) methods of examination and treatment, serious concomitant diseases (diabetes mellitus, neutropenia). Any urinary tract infections in men are treated as complicated.

It is important to distinguish between community-acquired (occur on an outpatient basis) and nosocomial (develops after 48 hours of the patient's stay in the hospital) infections of the urinary tract.

MAIN PATHOGENS

Uncomplicated infections More than 95% of MEPs are caused by a single microorganism, most often from the family Enterobacteriaceae. The main causative agent is E.coli- 80-90%, much less often S.saprophyticus (3-5%), Klebsiella spp., P. mirabilis and others. complicated infections MVP allocation frequency E.coli decreases, other pathogens are more common - Proteus spp., Pseudomonas spp., Klebsiella spp., mushrooms (mainly C.albicans). Kidney carbuncle (cortical abscess) in 90% is caused by S. aureus. The main causative agents of apostematous pyelonephritis, kidney abscess with localization in the medullary substance are E.coli, Klebsiella spp., Proteus spp.

As with other bacterial infections, the sensitivity of pathogens to antibiotics is crucial in choosing a drug for empirical therapy. In Russia, in recent years, there has been a high frequency of resistance of community-acquired strains. E.coli to ampicillin (uncomplicated infections - 37%, complicated - 46%) and co-trimoxazole (uncomplicated infections - 21%, complicated - 30%), therefore, these AMPs cannot be recommended as drugs of choice for the treatment of urinary tract infections. The resistance of uropathogenic strains of Escherichia coli to gentamicin, nitrofurantoin, nalidixic acid and pipemidic acid is relatively low and amounts to 4-7% in uncomplicated and 6-14% in complicated UTIs. The most active are fluoroquinolones (norfloxacin, ciprofloxacin, etc.), the level of resistance to which is less than 3-5%.

CYSTITIS

ACUTE UNCOMPLICATED CYSTITIS

Drugs of choice: oral fluoroquinolones (levofloxacin, norfloxacin, ofloxacin, pefloxacin, ciprofloxacin).

Alternative drugs: amoxicillin/clavulanate, fosfomycin trometamol, nitrofurantoin, co-trimoxazole.

Duration of therapy: in the absence of risk factors - 3-5 days. Therapy with a single dose is inferior in effectiveness to 3-5-day courses. Only fosfomycin trometamol is used once.

ACUTE COMPLICATED CYSTITIS

Acute complicated cystitis or presence of risk factors(age over 65 years, cystitis in men, persistence of symptoms for more than 7 days, recurrence of infection, use of vaginal diaphragms and spermicides, diabetes mellitus).

Choice of antimicrobials

Alternative drugs: oral cephalosporins II-III generation (cefuroxime axetil, cefaclor, cefixime, ceftibuten), co-trimoxazole.

Duration of therapy A: 10-14 days.

SEVERE AND COMPLICATED PYELONEPHRITIS

Hospitalization required. Treatment, as a rule, begins with parenteral preparations, then, after normalization of body temperature, they switch to oral antibiotics.

Choice of antimicrobials

Drugs of choice: parenteral fluoroquinolones amoxicillin/clavulanate, ampicillin/sulbactam.

Alternative drugs: parenteral cephalosporins II-IV generation cefoperazone / sulbactam, ticarcillin / clavulanate, ampicillin + carbapenem aminoglycosides (imipenem, meropenem).

Duration of therapy: parenteral administration of antibiotics until the fever disappears, then switching to oral antibiotics, as in mild to moderate pyelonephritis. The total duration of antimicrobial therapy should be at least 14 days and be determined by the clinical and laboratory picture.

APOSTEMATOUS PYELONEPHRITIS, RENAL ABSCESS

Therapy is carried out in a specialized urological hospital. If necessary, surgical treatment.

Choice of antimicrobials

Cortical abscess

Abscess of the medullary substance, apostematous pyelonephritis

Drugs of choice: parenteral fluoroquinolones (levofloxacin, ofloxacin, pefloxacin, ciprofloxacin), amoxicillin/clavulanate, ampicillin/sulbactam.

Alternative drugs: parenteral cephalosporins II-IV generation (cefuroxime, cefotaxime, ceftriaxone, cefoperazone, cefepime), cefoperazone / sulbactam, ticarcillin / clavulanate, ampicillin + aminoglycosides (gentamicin, netilmicin, amikacin), carbapenems (imipenem, meropenem).

Duration of therapy: 4-6 weeks, determined by the clinical and laboratory picture. The first 7-10 days parenteral administration, then it is possible to switch to taking AMPs orally.

FEATURES OF THE TREATMENT OF INFECTIONS IN PREGNANCY

Alternative drugs: nitrofurantoin.

Duration of therapy A: 7-14 days.

pyelonephritis

Alternative drugs: aminoglycosides, ampicillin, amoxicillin ampicillin/sulbactam, aztreonam.

Duration of therapy: at least 14 days.

PECULIARITIES OF THE TREATMENT OF INFECTIONS OF THE UTI DURING BREASTFEEDING

During lactation, the use of fluoroquinolones is contraindicated, and the use of co-trimoxazole is undesirable during the first 2 months of breastfeeding. If it is impossible to carry out alternative therapy, it is allowed to prescribe the above drugs when transferring the child to artificial feeding for the period of treatment.

PECULIARITIES OF THE TREATMENT OF UTI INFECTIONS IN ELDERLY PEOPLE

In the elderly, the incidence of urinary tract infections is significantly increased, which is associated with complicating factors: benign prostatic hyperplasia in men and a decrease in estrogen levels in women during menopause. Therefore, the treatment of urinary tract infections should include not only the use of AMPs, but also the correction of the described risk factors.

With benign prostatic hyperplasia, medical or surgical treatment is carried out; in women during menopause, local vaginal use of estrogenic drugs is effective.

Kidney function in the elderly is often reduced, which requires special care when using aminoglycosides. There is a high frequency of HP when using, especially long-term, nitrofurantoin and co-trimoxazole. Therefore, these drugs should be prescribed with caution.

PECULIARITIES OF THE TREATMENT OF MVP INFECTIONS IN CHILDREN

The spectrum of pathogens in children does not differ from that in adults. The leading stimulus is E.coli and other members of the family Enterobacteriaceae. In moderate and severe pyelonephritis, children of the first 2 years of life are recommended to be hospitalized. Usage

The genitourinary system is at high risk due to poor lifestyle and infectious diseases.

With age, these risks increase significantly, so the state of the organs responsible for sexual and urinary function should be given more and more attention.

Since the organs in the system are connected, the deterioration of the state of one leads to risks for the other, therefore, in order to avoid serious consequences, the treatment of diseases of the genitourinary system should be as fast and of high quality as possible.

Infectious diseases are the most common pathology of the genitourinary system. Modern medicine has many such diseases, most often caused by bacteria or fungi.

Inflammations are often diagnosed with a delay, since they usually go unnoticed by the patient, sometimes they can only be recognized by complications in other organs.

The structure of the male genitourinary system

Most often, inflammatory processes that have begun in the genitourinary system can be found in the following:

• external manifestations on the genitals;
• lack of erection.

Prostatitis

Of all the disorders of the genitourinary system, the largest number of cases occur in, which, in fact, is an inflammation of the prostate gland caused by bacteria (most often chlamydia).

Diagnosis is complicated by hidden and the fact that many other diseases are common.

Symptoms:

• painful urination;
• weak;
• discomfort in the lower abdomen;
• small amount of urine.

Urethritis

The disease is characterized by an inflammatory process inside the urethra. It may not manifest itself for a long time, and later make itself felt under, or another disease. The main source of infection is unprotected intercourse.

Symptoms:

• burning sensation when urinating;
• pain and itching;
• discharge;
• pain and cramps are felt in the lower abdomen.

With untimely treatment, inflammation of other organs is possible.

BPH

• frequent urination (sometimes with interruption of sleep);
• weak intermittent urine stream;
• feeling of incomplete emptying of the bladder;
• inability to urinate without straining;
• urinary incontinence.

Cystitis

For complex therapy, Ursulfan or is used. Of the plant uroantiseptics, Phytolysin is most often used. To relieve pain, antispasmodics are used:, etc.

Of the diuretics, Diuver or Furosemide is used. Multivitamin complexes Alvittil, Milgamma, Tetrafolevit are excellent for stimulating the immune system, preparations containing selenium and are additionally prescribed.

Diet

Diets are prescribed most often for kidney diseases:

• diet number 6. Helps limit salt intake, increase the proportion of dairy products, liquids, vegetables and fruits in the diet;
• diet number 7a. Allows you to remove metabolic products from the body, reduce pressure and swelling.
• diet number 7b. Increases the amount of proteins compared to 7a.

Depending on the type of disease, there are many types of prescribed diets, they are prescribed only by the attending physician based on the results of the tests.

Physiotherapy

The main purpose of physiotherapy for urological diseases is to strengthen drug treatment. It is also used to directly eliminate certain diseases or is used in cases where medications are contraindicated for the patient.

The main types of applied procedures:

• EHF-therapy;
• ultrasound treatment;
• electrophoresis;
• inductothermy.

Therapy with folk remedies

In parallel with drug treatment, they are used. Infection in the urinary tract destroys coconut oil (used orally), asparagus and celery help relieve inflammation.

Coconut oil is great for infection

An infusion of boiled onions and basil is used as an antibacterial and diuretic. Garlic is useful in kidney diseases.

For the greatest effectiveness, drugs, folk remedies and physiotherapy are used in combination.

Prevention of inflammatory diseases

The main element in the prevention of diseases of the genitourinary system is hygiene, which includes both regular washing and protected sex.

Despite the simplicity, many ignore these measures. The absence of hypothermia, leading, for example, to cystitis, guarantees the right clothing for the season. To help the body get rid of harmful bacteria, you need to drink 1.5 to 2.5 liters of fluid per day.

They will help to normalize the functioning of the body. Proper nutrition, activity and the rejection of bad habits will help to significantly reduce the risk.

With proper prevention and attention to your health, you can greatly reduce the risk of developing urological diseases.

Related videos

About the principles of treatment of diseases of the genitourinary system in the video:

Pathologies of the genitourinary system pose a huge threat to the body up to the danger of death. But it is not difficult to prevent these diseases by following a number of simple recommendations. A timely visit to the doctor will help prevent complications and make the treatment as simple, quick and painless as possible.

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Classmates

One of the most common reasons for visiting a urologist today are genitourinary infections, 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 - and in the absence of therapy, they become chronic. 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):

• Pyelonephritis is an inflammation of the parenchyma and tubular system of the kidneys, accompanied by pain in the lower back of varying intensity and intoxication (fever, nausea, weakness, chills).
• Cystitis is an inflammatory process in the bladder, the symptoms of which are frequent urge to urinate with an accompanying feeling of incomplete emptying, sharp pain, and 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 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 streptococci. Thus, even before laboratory tests, the best option would be antibiotic treatment for infections of the genitourinary system.

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 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:

• Ampicillin. 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.
• Amoxicillin. 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 Flemoxin Solutab and Hiconcil are also used, as well as combined antibiotics for the treatment of the genitourinary system (with clavulanic acid) - Amoxicillin / Clavulanate, Augmentin, Amoxiclav, Flemoklav Solutab.

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 Co-trimoxazole (Biseptol) is practically not used in urological practice.

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:

• Cephalexin. An effective medicine for inflammation of all organs of the urogenital area for oral administration with a minimum list of contraindications.
• Cefaclor (Ceclor, Alfacet, Taracef). It belongs to the second generation of cephalosporins and is also used orally.
• Cefuroxime and its analogues Zinacef and Zinnat. Available in several dosage forms. They can be prescribed even to children of the first months of life due to low toxicity.
• Ceftriaxone. Sold in the form of a powder for the preparation of a solution, which is administered parenterally. Substitutes are Lendacin and Rocephin.
• Cefoperazone (Cefobide). A representative of the third generation of cephalosporins, which is administered intravenously or intramuscularly for genitourinary infections.
• Cefepime (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). Due to toxicity and permeability of the placental barrier, children, pregnant and lactating women are not prescribed.

• Ciprofloxacin. Taken orally or parenterally, it is well absorbed and quickly eliminates painful symptoms. It has several analogues, including Tsiprobay and Tsiprinol.
• Ofloxacin (Ofloxin, Tarivid). The antibiotic fluoroquinolone is widely used not only in urological practice due to its effectiveness and wide spectrum of antimicrobial activity.
• Norfloxacin (Nolicin). Another drug for oral, as well as intravenous and intramuscular use. It has the same indications and contraindications.
• Pefloxacin (Abactal). 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 tendinitis.

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.

• Gentamicin. 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.
• Amikacin. 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 Fosfomycin 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. Approved for use at any stage of pregnancy, practically does not give side effects, can be used in pediatrics (from 5 years old).

When and how are antibiotics used for MPI?

Normally, the urine of a healthy person is practically sterile, but the urethra also has its own microflora on the mucosa, so asymptomatic bacteriuria (the presence of pathogenic microorganisms in the urine) is diagnosed quite often. This condition does not manifest itself externally and in most cases does not require therapy. The exceptions are pregnant women, children and people with immunodeficiency.

If large colonies of E. coli are found in the urine, antibiotic treatment is necessary. In this case, the disease occurs in an acute or chronic form with severe symptoms. In addition, antibiotic therapy is prescribed with long low-dose courses to prevent relapses (when an exacerbation occurs more than twice every six months). The following are regimens for the use of antibiotics for genitourinary infections in women, men and children.

Pyelonephritis

Mild to moderate disease is treated with oral fluoroquinolones (eg, Ofloxacin 200–400 mg twice daily) or inhibitor-protected amoxicillin. Reserve drugs are cephalosporins and co-trimoxazole. Pregnant women are hospitalized with initial therapy with parenteral cephalosporins (Cefuroxime), followed by a switch to tablets - Ampicillin or Amoxicillin, including clavulanic acid. Children under 2 years of age are also placed in a hospital and receive the same antibiotics as pregnant women.

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. Uncomplicated infection in adults is usually treated for 3-5 days with fluoroquinolones (Ofloxacin, Norfloxacin and others). Reserve 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, the drugs of choice are Amoxicillin or Monural, alternative - Nitrofurantoin. Children are prescribed a seven-day course of oral cephalosporins or Amoxicillin with potassium clavulanate. Monural or Furadonin are used as reserve funds.

Additional Information

It should be borne in mind that in men, any form of MPI is considered complicated and is treated according to the appropriate scheme. In addition, complications and 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.

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The main drugs for the treatment of the genitourinary system are antibiotics. Before the appointment, it is necessary to pass a urine culture for sterility, and determine the reaction of microorganisms obtained from it to antibacterial drugs. Without sowing, it is better to use broad-spectrum medicines. But some differ in nephrotoxicity (toxic effects on the kidneys), for example, "Gentamicin", "Polymyxin", "Streptomycin".

Treatment of infections with antibiotics

For inflammation of the urinary tract, antibiotics of the cephalosporin group are used - "Cefalexin", "Cefaclor", "Cefepim", "Ceftriaxone". With inflammation of the kidneys, semi-synthetic penicillin is also used - "Oxacillin" and "Amoxicillin". But it is better for urogenital infections - treatment with fluoroquinolone - Ciprofloxacin, Ofloxacin and Gatifloxacin. The duration of antibiotic use for kidney disease is up to 7 days. In complex treatment, drugs with sulphenylamide are used - "Biseptol" or "Urosulfan".

Herbal uroantiseptics

"Canephron" in case of illness

In urology, herbal uroantiseptics are used both as the main healing substances and as auxiliary ones. « Kanefron is an excellent remedy for the treatment of diseases of the genitourinary system. It has anti-inflammatory and antimicrobial action, causes a diuretic effect. It is used orally in the form of drops or dragees. The composition of "Kanefron" includes rose hips, rosemary leaves, centaury and rosemary. With inflammation of the kidneys, 50 drops of the drug or 2 tablets are prescribed 3 times a day. In men, it is considered the best remedy in the treatment of urinary infections.

"Fitolysin" - a remedy for infections of the genitourinary system, facilitates the passage of stones and removes pathological agents from the urinary tract. Mint, pine, orange, sage and vanillin oils are added to the preparation. Take anti-inflammatory after meals 3 times a day, 1 tsp. half a glass of warm water. Kidney disease resolves within a month. It is made in the form of a paste to obtain a solution. The composition of "Fitolysin" - extracts:

• horsetail;
• parsley;
• birch leaves;
• rhizomes of wheatgrass;
• fenugreek;
• hernia;
• onion bulbs;
• goldenrod;
• herbs mountaineer bird.

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Medications to relieve symptoms of inflammation of the genitourinary system

Inflammation of the urinary tract begins to be treated with drugs that stop the inflammatory symptoms and restore the functionality of the urinary tract. The main medicines for the genitourinary system are Papaverine and No-shpa. Doctors recommend using antibacterial agents after a course of antispasmodics. In parallel, they are treated with tablets that do not have the property of nephrotoxicity.

For diseases of the genitourinary system, paracetamol is used. The daily dose is 4 times 650 mg. When taking paracetamol, drink plenty of water to ensure normal hemodynamics. Ibuprofen is shown instead of paracetamol. The daily dose is 4 times 1200 mg. Other drugs for relief of symptoms: Ketanov, Nimesulide, Cefekon and Baralgin. The decision in therapy with nephrotoxic drugs is justified, and therapy is prescribed only after consulting a doctor.

Antispasmodics

Antispasmodic drugs improve urine flow and relieve pain. Popular tablets are the same "Papaverine" with "No-shpa" and "Benziklan" with "Drotaverine". "No-shpa" is available in the form of tablets and solution. Dosage - no more than 240 mg per day. "No-shpu" is strictly forbidden to take with heart and liver failure. Additionally, it is allowed to take "Kanefron" - it has both antispasmodic and antiseptic effects.

Diuretics are diuretics. Treatment with diuretics should be treated with caution. They can cause kidney failure and complicate the disease. Therapy is applied only after the appointment of a doctor. The main drugs for urinary tract infections: "Diuver", "Hypothiazid", "Furomeside" and "Aldakton". Dose - 1 tablet per week. To maintain water balance in the body, calcium, potassium, saline solutions are taken in combination with diuretics, and hemosorption and hemodialysis are carried out.

Immunostimulation in diseases of women and men

With a disease in men and women of the kidneys and urinary tract, you need to drink decoctions that contain vitamins: rosehip, birch tree leaves, mountain ash, currant leaf, knotweed. Doctors also prescribe multivitamin preparations, which include a complex of trace elements with vitamins. Medicines to increase immunity in kidney diseases - Alvittil, Aerovit, Askorutin, Tetrafolevit, Milgamma. In parallel with vitamins, minerals such as selenium and zinc are taken.

Folk remedies

• Cranberry juice will help relieve inflammation of the genitourinary system. It acts as a diuretic and prevents bacteria from multiplying.
• Unrefined coconut oil is used to kill urinary tract infections. Oil is consumed in 2 tbsp. in a day. Coconut milk contains good medicinal substances, it should be drunk on an empty stomach in the morning and a glass before bedtime.
• Inflammation of the urinary tract relieves asparagus. When eating asparagus, the color of the urine darkens, which should not be scary.
• Garlic is good for kidney problems. Peel 2 cloves of garlic, crush and pour 1 glass of water, leave for 5 minutes and drink. The procedure is repeated 3 times a day until the symptoms disappear.
• Onion - antibacterial and diuretic, promotes rapid recovery of the kidneys and urinary tract. The onion is cut into 4 equal parts, 0.5 l of water is added and boiled for 20 minutes over low heat, insisted for 8 hours, filtered and drunk.
• Inflammation of the urinary tract is treated with celery. Beat the stems, add pineapple and 200 ml of chamomile infusion. The mixture is drunk in the morning on an empty stomach. Celery seed is also used. The seed is steamed in 1 cup of hot water, infused for 10 minutes and drunk 2 times a day.
• Good infusion with basil. 2 tablespoons are added to 1 glass of water. plants, insist 10 minutes. Drink 2 days 2 times a day.

In addition to the main folk remedies for the treatment of the genitourinary tract, there are delicious recipes for alternative medicine. It is recommended to drink juice from 1 banana and an apple for a week (2 times a day). Eat at least 3 pieces of watermelon per day. In addition to medicinal qualities, it also acts as a prophylactic. A berry cocktail with cherries, cherries, blueberries and a slice is recommended, which should be drunk only on an empty stomach.

Means for prevention

Often prescribed medications of the fluoroquinolone group - "Levofloxacin", "Ciprofloxacin" or "Gatifloxacin". Inflammation of the urinary tract can be prevented by herbal medicine. Herbal infusions can be taken for a long time, there are practically no side effects from them. Optimal collection of herbs - mint, goldenrod, angelica, horsetail, bearberry. Ready-made preparations - "Canephron" or "Uriklar", which have antiseptic and anti-inflammatory effects. Candles for infections of the genitourinary system in women are especially popular ("Vitaferon", "Indomethacin", "Cystitis" and "Voltaren").

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.

• antibacterial agents;
• NSAIDs;
• uroseptics;
• drugs for symptomatic treatment;
• immunomodulators.

The main task of treating urinary tract infections is to eliminate the pathogen and suppress infectious inflammation. To solve it, various antibacterial drugs are used. The question of choosing the optimal drug is not easy. And only a doctor can make the right choice. Judge for yourself how many factors need to be taken into account: the total duration of the disease (including episodes of urinary tract infection in childhood), the body's response to antibiotic therapy during previous exacerbations, the state of kidney function, urinary tract patency, existing concomitant diseases (for example, diabetes mellitus, cardiovascular diseases, diseases of the stomach and intestines), medications taken, etc. It is also important to know the type of pathogen and its sensitivity to antibiotics. You are unlikely to be able to answer many of these questions, and self-medication is more likely to hurt yourself than help. We will give you some tips on how to properly take the drugs prescribed by your doctor.

Several groups of antibacterial drugs are currently used to treat urinary tract infections.

Antibiotics

Many drugs in this group have nephrotoxicity, that is, the ability to damage kidney tissue. Some drugs always show this property (absolutely nephrotoxic), others - under certain conditions: in the presence of renal failure, against the background of dehydration of the body or its sharp weakening due to severe concomitant pathology. Based on this, absolutely nephrotoxic antibiotics for the treatment of urinary tract infections are not prescribed. Semi-synthetic combined penicillin derivatives, cephalosporins and fluoroquinolone preparations are recognized as optimal antibiotics today. It is pointless to list the names of drugs, since their list can take more than one page. And only the attending physician can give you recommendations on how to take a particular remedy, this is his prerogative.

The duration of antibiotic treatment is 10-14 days. The strict timing of their intake is due to the ability of antibiotics to influence the life expectancy and the reproduction cycle of microorganisms. Interruption of the course of treatment is fraught with unpleasant consequences, primarily the transition of the disease to a latent (hidden) form due to the “addiction” of bacteria to the drug and their loss of sensitivity to the drug and its analogues. A properly selected antibiotic leads to an improvement in the condition, the disappearance of urination disorders (polyuria and nocturia) by 3-4 days of treatment. However, this does not mean the elimination of the infection. Complete destruction of the pathogen is observed only by the 10-14th day of treatment. Clinical cure will be indicated not only by a significant improvement in the condition, but also by the absence of changes in urine and blood tests.

Due to the possible risk of kidney failure, antibiotics should always be combined with sufficient fluids (of course, except in cases of severe heart failure and high blood pressure, when fluid intake is limited).

Sulfanilamide preparations

Perhaps this group of antibacterial agents is the most popular among the people. The slightest cold, cough, malaise pushes us to the pharmacy to buy Biseptol. The medicine is cheap, effective (alas, it used to be), easy to use. Why "alas"? The wide availability of the drug led to the fact that most of the pathogens that were successfully destroyed by biseptol and its analogues adapted to the drug, learned to integrate it into their metabolism, and therefore lost sensitivity to it. We prescribe medicine to treat, but we see the opposite result.

Of course, this does not mean that it is useless to take sulfonamides. Exacerbation of chronic urinary tract infection is not always caused by the same pathogen. In addition, there are people who rarely resort to the use of antibacterial agents during their lives. In such cases, biseptol can be very effective.

Duration of treatment sulfonamides is less than the duration of antibiotic treatment. When prescribing sulfonamides, there is a danger of their falling into a crystalline precipitate in the lumen of the renal tubules. To exclude this possibility, sulfonamides must be washed down with a large amount of alkaline mineral water. The water must be degassed. In renal failure, sulfa drugs are not prescribed.

However, we repeat once again that the effectiveness of sulfonamides is low due to the high resistance of pathogens to them, and therefore today this group of drugs is practically not used to treat urinary tract infections.

Nitrofuran preparations

This group of drugs includes furadonin, furagin, furazolidone, blacks, negramon, etc. They are moderately effective in chronic sluggish urinary tract infections in elderly and senile people. Restriction to their use is also renal failure. Medium duration of treatment nitrofuran means - from 7 to 10 days.

Oxolinic acid derivatives

Special mention should be made of these medicines. Popular rumor ascribes nitroxoline(5-NOC) miraculous properties and 100% effectiveness. Where this conviction came from is anyone's guess. Firstly, the main pathogens of pyelonephritis have extremely low sensitivity to oxolinic acid derivatives. Secondly (more importantly), the drugs of this group do not create the necessary therapeutic concentrations in the kidney tissue, urine and blood serum. And if so, then one should not expect miracles: 5-NOC and its analogues are not able to eliminate the infectious focus in the kidney. Therefore, most countries around the world have abandoned the use of these drugs for the treatment of urinary tract infections.

Pipemidic acid preparations

Antibacterial drugs of this group (palin, urotractin, pimidel, pipemidine, pipemidic acid) are quite effective in men suffering from a urinary tract infection against the background of prostate adenoma. Usually the drug is prescribed 1 capsule 2 times a day after meals. Duration of treatment- 10-14 days.

Herbal uroantiseptics

Herbal medicines are widely used in urological practice. They are prescribed during the period of exacerbation of infectious diseases of the urinary system as an auxiliary antiseptic, anti-inflammatory agent. In addition, they are used for prophylactic purposes to prevent recurrence of the disease.

Of the herbal preparations that have the ability to disinfect urine at the level of the urinary tract, Canephron, Uroflux, Fitolizin, kidney collections and teas are prescribed.

Kanefron

"Kanefron" - a combined preparation of plant origin. It has antimicrobial, antispasmodic and anti-inflammatory effects. It has a pronounced diuretic effect. Produced "Kanefron" in the form of dragees or drops for oral administration.

The drug "Canephron"

The dragee includes powders of centaury herb, rosehip peel, lovage root, rosemary leaves. Drops are prepared on the basis of extracts of the same plants. Usually, for the treatment of urinary tract infections, 2 tablets or 50 drops of the drug are prescribed 3 times a day. The duration of taking "Kanefron" is determined by the nature of the course of the disease.

Phytolysin

"Fitolizin" has indications and medicinal properties similar to those of "Canephron". In addition, it facilitates the passage of stones. The drug is available in the form of a paste for the preparation of a solution. It contains plant extracts: parsley root, wheatgrass rhizomes, horsetail herb, birch leaves, knotweed herb, onion bulbs, fenugreek seed, goldenrod herb, hernia herb. It also includes oils - mint, sage, pine, orange and vanillin. Take Fitolizin 1 teaspoon in 1/2 cup of warm, sweetened water 3 times a day after meals.

Other herbal uroantiseptics can be prepared at home. When choosing herbal medicine, one should take into account the presence of kidney-friendly effects of medicinal plants: diuretic, anti-inflammatory, tanning and hemostatic.

The alternation of plant fees is considered optimal. And another important point. No need to condemn yourself to lifelong intake of kidney teas and fees. It is necessary to be treated only if there are indications: either during an exacerbation, or prophylactically to prevent a re-exacerbation of a urinary tract infection during colds, with an increase in signs of urination disorders, etc.

Treatment of an exacerbation of a urinary tract infection is considered effective if, at the end of it, there are no signs of the disease for the next six months, and there are no leukocytes and bacteria in the urine tests.
Antibacterial treatment is aimed at eliminating the infection - the cause of inflammation. Therefore, it is also called etiotropic (“etios” - the reason, “tropic” - having an affinity, relation; related to the reason).

The main properties of medicinal plants used in diseases of the urinary tract.

Symptomatic treatment

To eliminate signs of infectious intoxication, normalize blood pressure, correct anemia, symptomatic treatment is prescribed (“symptom” is a sign of the disease; symptomatic treatment is treatment aimed at eliminating the manifestations of the disease).

I would like to make one caveat. Sometimes, to enhance the diuretic effect of herbal preparations, patients take diuretics - diuretics(hypothiazide, furosemide, etc.). The consequence of such self-medication may be acute renal failure. Its reason is simple: diuretics cause forced urination, and the renal tubules are inflamed, their lumen is narrowed, contains bacteria, desquamated epithelium, leukocytes, and mucus. Because of this, sometimes, the tubules become completely impassable for urine. And "the puck is already thrown in." The diuretic works by pushing urine toward the tubules. The result is sad - an acute violation of kidney function, that is, acute renal failure.

What about diuretics? Don't take them at all? Only a doctor can make a decision. He knows when, at what dose, and with what frequency to prescribe a certain diuretic. Specifically, because each diuretic works in different parts of the renal tubules.

And one more knot for memory. Many people, when the slightest pain appears, take analgesics (analgin, paracetamol, diclofenac, aspirin, etc.). All painkillers with uncontrolled use have a detrimental effect on the medulla of the kidney: on the tubules and interstitium. And pyelonephritis is a disease of precisely these structures of the kidney. Therefore, the question of the use of analgesics in pyelonephritis should be decided carefully and always by a doctor.

vitamin therapy

To activate the immune forces of the body, the speedy elimination of inflammatory disorders, vitamin preparations are necessarily included in the treatment of urinary tract infections. There can be no specific recommendations here. All vitamins sold in the pharmacy chain are good. No need to chase expensive, imported vitamins. The composition and effectiveness of domestic drugs are similar to those of foreign drugs, but they are much cheaper. It is advisable to take multivitamins with trace elements - complex preparations, which include all the vitamins and trace elements necessary for the human body (iron, iodine, calcium, potassium, magnesium, manganese, copper). For elderly and senile people, domestic multivitamins "Dekamevit" (take 1 yellow and 1 orange tablet 1-2 times a day after meals; the duration of the course of treatment is 20 days), "Undevit" (2 tablets 3 times a day) may be optimal. within 20-30 days).

Physiotherapy

Prevention of pyelonephritis

In addition to the preventive measures described in the article “Acute and chronic cystitis”, it is recommended to drink fluids in an amount of at least 2 liters / day, regular urination, mandatory urination at night, if there is an urge to urinate, fighting constipation. In some people, pyelonephritis worsens several times a year, has a protracted, severe course. In such cases, anti-relapse courses are necessarily added to the general preventive measures, including several antibacterial drugs, vitamins, diuretics, herbal antiseptics and agents that stimulate the immune system. The scheme of anti-relapse treatment and its duration is chosen only by