4. Antibiotics

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© Springer Nature Switzerland AG 2020
B. Yang, S. Foley (eds.)Female Urinary Tract Infections in Clinical PracticeIn Clinical Practicedoi.org/10.1007/978-3-030-27909-7_4



4. Antibiotics



Yih Chyn Phan1   and Bob Yang2


(1)
Queen Alexandra Hospital, Portsmouth, UK

(2)
Royal Berkshire Hospital, Reading, GB, UK

 



 

Yih Chyn Phan



The common classes of antibiotics used to treat UTIs that clinicians should be familiar with include penicillin, cephalosporin, carbapenems, fluoroquinolones, aminoglycosides, and fosfomycin. These are explored further below and summarised in Table 4.1.


Table 4.1

Summary of antibiotics used in urinary tract infections

































































Class of antibiotics


Type of antibiotics


Mechanism of action


Commonly used names of antibiotics


Comments


Trimethoprim


Bacteriostatic


Inhibits bacterial thymidine synthesis


N/A


Being a folate antagonist, trimethoprim should not be prescribed for pregnant ladies who are in their first trimester


Nitrofurantoin


Bacteriostatic


Believed to be inhibition of several bacterial enzymes involved in the synthesis of DNA, RNA and other bacterial metabolic enzymes


N/A


Not to be used in pregnant ladies who are in their third trimester as it may induce neonatal haemolysis. Risk of lung fibrosis and hepatotoxicity


Penicillin


Bactericidal


Interferes with bacterial cell wall synthesis


Ampicillin


Amoxicillin


Flucloxacillin


Penicillin V


Benzylpenicillin


Piperacillin


Contraindicated in patients who have hypersensitivity to penicillin. Encephalopathy is also another rare but serious side of penicillin


Fluoroquinolones


Bactericidal


Inhibits DNA gyrase


Ciprofloxacin


Levofloxacin


Ofloxacin


Moxifloxacin


Norfloxacin


Contraindicated if patients have a history of tendon rupture or tendonitis


Aminoglycoside


Bactericidal


Inhibits bacterial protein synthesis


Gentamicin


Neomycin


Amikacin


Tobramycin


Streptomycin


Well known side effects of this class of medication are ototoxicity and nephrotoxicity


Fosfomycin


Bactericidal


Inhibits enzyme-catalyzed reaction in bacterial cell wall synthesis


N/A

 

Cephalosporin


Bactericidal


Disrupts bacterial cell wall synthesis


First generation: cefazolin, cephalexin


Second generation: cefoxitin, cefaclor, cefuroxime


Third generation: ceftriaxone, cefotaxime, ceftazidime


Fourth generation: cefepime


About 0.5–6.5% of penicillin-sensitive/allergic patients will also be sensitive to cephalosporins


Carbapenem


Bactericidal


Disrupts bacterial cell wall synthesis


Meropenem


Ertapenem


Imipenem


Doripenem

 

4.1 Trimethoprim


Trimethoprim is a bacteriostatic antibiotic which binds to dihydrofolate reductase and inhibits the reduction of dihydrofolic acid to tetrahydrofolic acid which is an essential precursor in the thymidine synthesis pathway in bacterial DNA synthesis.



  • The dosage of trimethoprim to treat UTI is usually 200 mg BD.

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Mar 23, 2021 | Posted by in UROLOGY | Comments Off on 4. Antibiotics
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