UTI in pregancy

Q: 7: Back to basics : What  is  the  Bacteriology: Varies from country, socio economic status  , ethnicity, personal hygiene, Slum dwellers  ,toilet facilities, napkin use, the basic teaching by mother about maintaing hygiene of vulva & perineum, use of tissue paper about cleaning of anal opening  after each act of defecation  counts.  I am not sure whether my granddaughters are taught about this personal, hygiene by their mothers neither I am aware of what other Lady members of this prestigious group can afford time to teach their toddlers (girls),   and personal immunity. The fact remains that the organism crawls up from perineum is the common source of Lower UTI infection.

 

Q  8:-Where from the thief entered the Bank??  Third etiology of  Asymp bact(after 1) travel of bact/cocci from unclean perineum / 2) dribbling of last few drops of urine in birth canal)   is  rough sexual intercourse more so if husband is infected,(sexual STI or nonsexual STI)

 

Q.9, Forget about Symptomatic UTI with fever, dysuria, burning sensation where diag s obvious. How best to daig nose Asymp  UTI??  Ans to Q 9:-In Asymp bact as per dictum of pathology the colony  count is > 100 000 /mL in a midstream un spun urine. But if colony count is below that the clinician may refer to another lab if she/ he wishes to be doubly sure and if acceptable and affordable by the preg woman.

 

Q. 10: Can we avoid visit to lab and how reliable is clinic test for Asymp bact ?? Ans;- Of note that tets a) Dipstick for nitrites and b)  leukocyte  esterase  are is not that helpful  in to exclude UTI, nowadays. (Source: Hand book of Obstetric Medicine “ 5^th Edition:  Ed Catherine Nelson –Piercy::  Consultant Obstet physician &  Professor of Kings College London)-low Priced very useful book) May procure from  CBC Press: Taylors & Fancin Group. 2013 Ed, ) Original publisher Taylor & Francis,   ISNBN: 13-978-1-4987-8431-3.

 

Q.11. :-Which drug to choose blindly as combating common uropathogens::??  How to tr Asymp Bacteriuria: Ans;-Though science dictates that couture report will dictate us   about choice of most effective antibiotics still as an initial agent some drugs have to be used albeit empirically .Such initial   drugs before C/S report are available are the drugs likely) a) Amoxicillin (favourite drug-but repeated use in many indications-say Resp  tract  in childhood –premarital variety of infn have make this drug less effective in  child bearing age,. ), e) All kinds of Cephalosporins are al safe in first trimester, Of note that Cefadroxil or Cefetoxin 500 mg BD are  fortunately effective in most effective for most uropathogens. What about ampicillin? Unfortunately though nearly 100% safe its common use in childhood, like Amoxicillin  now resistant for common use in many diseases

Q. 12 : What about Nitrofurantoin ?? Any caution?? Ans;-Nitrofurantoin are  risky in  third trimester as it cases Neonatal hemolytic anemia,

 Q. 13:  Do not get involved in atomic war with your spouse!!! A great caution (should I say a warning from Dr Pal-your elder brother) on use of levofloxacilin, moxifloxacin, and gatifloxacin) Even I shall not prescribe these kinds of drugs for PID including  Ofolaxacilin for UTI/ BV /PID/ wound sepsis : Why ?? Ans; follows briefly: Once I was in atomic war with my wife. She insisted on Kanchvaram Sari about 15 yrs back when AICOG was held at the then Bangalore. I had no money as I don’t  have any Private practice  like our beloved Prof R--r

Q.  Indian Doctors mistake !! What are First-line antituberculosis drugs for Kocs as recommended by WHO ?? RNTPC? (Revised National Programme for control of TB):

·         2.1. Isoniazid. Isoniazid (INH) is one of the most effective and specific antituberculosis drugs, which has been a key to treatment since its introduction in 1952 [5]. ...

·         2.2. Rifampicin. ...

·         2.3. Pyrazinamide. ...

·         2.4. Ethambutol. ...

·         2.5. Streptomycin.

Mar 20, 2013

Dr Pal is drawing  attention to all learned members that Ofoxacilin is an important second line drug for Kochs including MDR Kochs(X-MDR agents),. So please think thrice before prescribing this drug including all  Fluoroquinolones levofloxacin, moxifloxacin, and gatifloxacin)

Treatment with later generation fluoroquinolones (defined here as high dose levofloxacin, moxifloxacin, and gatifloxacin) has been shown to significantly improve treatment outcomes in adults with rifampicin resistant or multi drug resistant TB. Second line drugs, recommendations after December 2018

The second line drugs to be used for the treatment of drug resistant TB after 2018 are shown in the table below.

The new guidelines mark a major change in the recommended treatment to be provided for those on "longer regimens". Longer MDR-TB regimens are treatments for MDR/RR-TB which last 18 months or more and which may be standardized or individualized. These regimens are usually designed to include a minimum number of second line TB medicines considered to be effective based on patient history or drug resistance patterns. The term "conventional" was previously used to refer to such regimens but was discontinued in 2016 when WHO first issed a recommendation for the use of a shorter MDR-TB regimen.

Injectable agents are no longer among the priority medicines to be used when designing longer MDR-TB regimens and WHO recommends that oral regimens should become the preferred option for most patients. It is a major step forward in the treatment of patients with drug resistant TB that patients are no longer required to have injectable drugs.