The consensus statement on the management of UTI(1) does a good job of
laying down guidelines for the clinician. However certain
recommendations need further clarification. The use of once a day
aminoglycosides needs to be emphasized adequately. Extensive data is now
available to show that once a day administration of aminoglycosides is
more convenient [since ideally it should not be pushed but given by a
slow infusion]. More importantly, toxicity of aminoglycosides is clearly
related to the duration for which serum levels remain high and adverse
effects are clearly lower with once a day aminoglycosides. When using a
group which has immense potential for nephrotoxicity in a renal
indication such as a UTI, every effort needs to be made to minimize the
iatrogenic nephrotoxicity that can be caused. Further, serum
aminoglycoside level monitoring is usually unnecessary when once a day
dosing is used (2). Hence the recommendation should be to use
aminoglycosides with extreme caution in such indications and only once
daily by slow i.v. infusion.
Secondly, in the area of
antimicrobials used for prophylaxis, cefadroxil can easily replace
cephalexin with an easy twice a day dosing and dosing unrelated to meals
with no loss of efficacy. We find hardly any mention about cefadroxil in
the Western literature since the molecule is prohibitively expensive in
the west as compared to cephalexin. However since cefadroxil is
affordable in our country, there is no reason to use cephalexin in any
indication and needs to be replaced by cefadroxil everywhere.
Thirdly, if the orignal
organism causing the UTI is resistant to the common list of prophylactic
agents such as cotrimoxazole, nitrofurantoin or cephalexin as is
commonly the case, can these medications still be used for prophylaxis
or should we use antibiotics as dictated by the original sensitivity
report and include medications such as norfloxacin, ciprofloxacin and
cefixime in our prophylactic regimens? Should we continue for
prophylaxis the antibiotic used to treat the original UTI?
Mukesh Sanklecha,
9c, 1st Floor, Sindh
Chambers,
Colaba, Mumbai 400 005,
India.
E-mail: [email protected]
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1. Bagga A, Babu
K, Kanitkar M, Srivastava RN. Consensus statement on the
management of Urinary Tract Infections. Indian Pediatr 2001; 38:
1106-1115.
2. Archer Gl, Polk RE. Treatment
and prophylaxis of bacterial infections. In: Harrison’s
Principles of Internal Medicine, 15th edn. Eds. Braunwald E,
Hauser SL, Fauci AS, Longo DL, Casper DL, Jameson LJ, New York,
McGraw Hill, 2001, pp 878-879.
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