Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034186 (pyelonephritis)
 6,144 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacteriuria is much more common among elderly than among younger populations, and is most often asymptomatic. Asymptomatic bacteriuria in the elderly is a benign condition in the vast majority of cases and does not require therapy. When symptomatic lower UTI occurs, short-course (3-day) therapy with any of several agents is indicated, and is usually effective. Women with frequently recurrent symptomatic UTI may benefit from estrogen therapy. Fourteen days of therapy is indicated in patients with upper UTI. The typical signs and symptoms of pyelonephritis may be altered or absent in elderly patients.
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PMID:Special problems of urinary tract infection in the elderly. 199 40

Escherichia coli (E. coli) causes greater than 90% of urinary tract infections, UTI, in childhood. The capacity to adhere to urinary tract epithelial cells characterizes E. coli strains that cause acute pyelonephritis. Adherence of uropathogenic E. coli is the result of a specific interaction between bacterial adhesins and glycolipid receptors on the host cells, especially the globoseries of glycolipids which share the Galactose alpha 1-greater than 4Galactose beta disaccharide (Gal alpha 1-greater than 4Gal beta). In childhood UTI, Gal alpha 1-greater than 4Gal beta-binding bacteria caused significantly higher body temperature, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and pyuria, and lower renal concentrating capacity, than E. coli lacking this specificity. The Gal alpha 1-greater than 4Gal beta-binding bacteria thus appeared to be more potent inducers of inflammation than other strains. Since inflammation may lead to tissue damage we examined the relationship of infection with Gal alpha 1-greater than 4Gal beta-positive bacteria to renal scarring. The frequency of renal scarring was 5% in boys with Gal alpha 1-greater than 4Gal beta-positive and 40% in boys with Gal alpha 1-greater than 4Gal beta-negative E. coli. Bacterial binding to Gal alpha 1-greater than 4Gal beta can be detected with a commercially available test reagent. This reagent can thus be used as an effective predictor of risk for renal scarring. Interleukin-6 (IL-6) is a pyrogen and inducer of the acute phase reactants. It was shown to be produced locally in the urinary tract, in response to UTI, and to spread systemically. Mucosal challenge with dead bacteria was sufficient to induce the IL-6 response. Circulating IL-6, and/or IL-1 and tumor necrosis factor could explain the fever, as well as increased ESR and CRP found in association with acute symptomatic UTI.
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PMID:Bacterial adherence as a virulence factor in urinary tract infection. 228 1

Clinical studies on S 6472, a longer lasting preparation of cefaclor (CCL), were performed and the following results were obtained. S 6472 was administered orally to 102 patients with urinary tract infections including 16 with acute uncomplicated pyelonephritis, 32 with acute uncomplicated cystitis, 31 with complicated pyelonephritis and 23 with complicated cystitis. 95 patients were treated with 375 mg of S 6472 2 times daily and 7 patients were treated with 750 mg of S 6472 2 times daily. The overall clinical efficacy was evaluated on the basis of the criteria proposed by the Japanese UTI Committee. 1. Clinical efficacies in 11 cases of acute uncomplicated pyelonephritis were excellent in 10 and moderate in 1, with an overall efficacy rate of 100%. Bacteriologically, all 12 strains identified in the acute uncomplicated pyelonephritis cases were eradicated, with an eradication rate of 100%. 2. Clinical efficacies in 21 cases of acute uncomplicated cystitis were excellent in 17, moderate in 3 and poor in 1, with an overall efficacy rate of 95%. As to bacteriological responses, 22 strains identified in the acute uncomplicated cystitis cases (except 1 of Escherichia coli) were eradicated, with an eradication rate of 95%. 3. Clinical responses in 43 cases of complicated urinary tract infections were excellent in 20, moderate in 15 and poor in 8, with an overall efficacy rate of 81%. Bacteriologically, 39 strains, including only one strain of P. aeruginosa, in the complicated urinary tract infection cases (except 4 of E. coli, 1 of Klebsiella pneumoniae, 1 of Enterococcus faecalis and 2 of Enterobacter cloacae) were eradicated, with an eradication rate of 83%. As side effects, slight stomatitis and gastric discomfort were noted in 1 patient each but we were able to continue the medication. Abnormal laboratory test values found were: 1 case of a slight and transient increase of lymphocytes in peripheral blood and 1 case of a slight and transient increase of serum creatinine level.
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PMID:[Clinical study of S 6472 in urinary tract infection]. 228 54

Eighty-two evaluable patients suffering from UTI were randomly treated with parenteral Aztreonam (1 g OD in cystitis and 1 g BID in pyelonephritis) or oral Norfloxacin (400 mg BID). Predisposing urological conditions were present in 75% and 78.5% respectively. Microbiological cultures at the end of treatment and at a follow-up visit after 4 weeks showed significantly better results among Aztreonam treated patients (microbiological cure: 97.5% vs 71.4%-p less than or equal to 0.005). Clinical cure was achieved in 97.5% and 71.4% respectively (p less than or equal to 0.001). A statistically significant difference was present only in patients treated for pyelonephritis (microbiological cure-AZT: 100%; NOR: 50%-p less than or equal to 0.0005) and not in those with cystitis (AZT: 95.0%; NOR: 83.3%). Side effects were rare in both treatments. Aztreonam seems to offer major advantages, when compared to Norfloxacin, in the treatment of UTI, especially when upper urinary tract is involved.
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PMID:[Aztreonam vs norfloxacin: a comparative study of the treatment of urinary tract infections in ambulatory and hospitalized patients]. 252 96

Ceftriaxone (CTRX) was evaluated for clinical efficacy on uncomplicated and complicated pyelonephritis by administering 2 g once daily for 5 days to 16 female patients between 20 and 65 years old (average: 39.7 years); i.e., 3 with uncomplicated pyelonephritis and 13 with complicated pyelonephritis. The pathogens in all 3 cases of uncomplicated pyelonephritis were E. coli. All of them disappeared after the treatment. Twenty-two strains of 10 strains of bacteria were isolated from the 13 cases of complicated pyelonephritis. Twenty of the 22 (91%) strains disappeared. The clinical efficacy was evaluated according to the Criteria for Evaluation of Clinical Efficacy of Antimicrobial Agents on UTI Japan in 15 cases except for 1 case of the complicated type where the CTRX administration was discontinued after the initial dose due to an adverse event. The efficacy rate was 100% in the 3 uncomplicated cases; 'excellent' in 1 case and 'good' in 2, and 92% in 12 of the complicated cases; 'excellent' in 9, 'good' in 2 and 'poor' in 1 (infection was with multiple pathogens including P. aeruginosa). No abnormal values were observed in any cases except for a slight increase in glutamic-pyruvic transaminase and alkaline phosphatase in one case and skin rash in another case which appeared following the initial dose and required the immediate withdrawal of the drug. CTRX is characterized by a long half-life and shows a strong antibacterial activity against GNRs, especially E. coli. The efficacy rate was high particularly following the initial dose in the acute stage of pyelonephritis.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical efficacy of ceftriaxone administered once daily against pyelonephritis]. 265 12

Cefixime (CFIX, Cefspan), a new oral cephem, was used in the treatment of urinary tract infections, and was evaluated for its therapeutic effectiveness and safety at the Department of Urology, Osaka University Hospital and 16 affiliated hospitals. A total of 238 patients were administered daily doses of 200 or 400 mg. Clinical efficacy was assessed on 92 female patients with acute uncomplicated cystitis and 42 patients with complicated UTI according to the Criteria for Clinical Evaluation of Antimicrobial Agents in UTI (3rd ed.) recommended by the Japan UTI Committee, to which we added our own minimum modification. Clinical efficacy was evaluated as excellent in 57 of the acute uncomplicated cystitis cases, moderate in 33 and poor in 2, with an overall clinical effectiveness rate of 98%. Clinical efficacy was evaluated as excellent in 12 of the complicated UTI cases moderate in 12 and poor in 18, with an overall clinical effectiveness rate of 57%. In one case of uncomplicated pyelonephritis, CFIX showed an excellent efficacy. Of the total of 102 bacterial strains isolated from uncomplicated UTIs, 95 (93%) were eradicated by CFIX, while 36 (72%) eradicated in 50 strains isolated from complicated UTIs. Subjective adverse reactions were seen in 4 cases (1.7%) of the 236 patients, as generalized pruritus and upper gastrointestinal discomforts. Abnormal laboratory findings were recorded in 6 out of 141 cases. They were increases in serum GPT, GOT, alkaline phosphatases, total bilirubin, as well as increases in peripheral leukocytes. These adverse symptoms and abnormal laboratory findings disappeared after the termination of CFIX administration. CFIX might therefore be considered as a clinically useful oral antibiotic in the treatment of UTI.
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PMID:[Clinical evaluation of cefixime (CFIX) in the treatment of urinary tract infection]. 267 90

Vesicoureteral reflux has the potential to cause irreversible renal damage if undiagnosed and untreated. It is important to have a high index of suspicion for the existence of a urinary tract infection in infants and children with any nonspecific generalized illness. Once a UTI is documented, appropriate antibiotic therapy must be started and continued until the urinary tract has been adequately evaluated radiographically. If vesicoureteral reflux is found to exist, appropriate medical or surgical therapy must be instituted to prevent further episodes of pyelonephritis.
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PMID:Current concepts in the management of common urologic problems in infants and children. 286 3

During the clinical development of ciprofloxacin 1,519 treatments of UTI were documented. The most frequent specific diagnoses were uncomplicated UTI (46.6%), followed by non-specified UTI (21.7%), complicated UTI (19.4%), acute pyelonephritis (7.6%) and chronic pyelonephritis (4.1%). 70% of the causative organisms isolated were Enterobacteriaceae (Escherichia coli 38%, Proteus spp. 10% and Klebsiella pneumoniae 10%). Pseudomonas aeruginosa occurred in approximately 20% of the cases and the remaining 10% were gram-positive aerobes. Clinical resolution was achieved in about 90% in all specific diagnoses. The eradication rate for gram-negative Enterobacteriaceae was 93.8%, for P. aeruginosa 81.8% and for gram-positive aerobes 90.2%. Studies comparing ciprofloxacin and standard treatment have shown the high efficacy of ciprofloxacin making it a preferred agent particularly for infections caused by pathogens less susceptible to conventional drugs. According to the experience of clinical trials the recommended ciprofloxacin dose varies between 100 and 500 mg b.i.d. orally depending on the severity of clinical status and the susceptibility of the pathogen.
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PMID:Clinical experience with ciprofloxacin in the treatment of urinary tract infections: a review. 306 43

Twenty-five children (16 females and 9 males) aged from 8 months to 10 years with clinical and laboratory evidence of UTI were treated with sulbactam + ampicillin (SBT/AMP). Twenty-four of them were suffering from cystitis and one from pyelonephritis. Four of them were treated unsuccessfully prior to entry in the trial. The mean final dose of SBT/AMP was 47.69 mg/kg/die (ratio of SBT-AMP was 1:2). The patients were treated for 3 to 8 days (mean: 4.76 days). 84% were treated by i.m. route. No side effects or adverse experience were reported. Clinical cure was achieved in 25 patients (100%).
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PMID:Clinical evaluation of sulbactam + ampicillin in the treatment of pediatric urinary tract infections. 321 51

The highest figure for first-time UTI is found in infants below one year of age. These early infections are often pyelonephritic in character, but they are easily overlooked because symptoms are unspecific, high fever and failure to thrive being the most important. It has been shown that delay in start of treatment increases the risk of the child developing pyelonephritic scarring. There is reason to believe that undetected and therefore untreated attacks of pyelonephritis may be associated with renal scarring revealed later in life. This type of renal damage is associated with development of hypertension in about 10 per cent of children and it accounts for around 20 per cent of the children entered into dialysis and transplant programs. Prevention of such long-term problems would be of great value and pyelonephritic scarring is a potentially preventable disease. The majority of infants and young children with UTI are probably managed at the primary care level. It is therefore essential that general practitioners are well informed about the epidemiology of UTI in infancy and childhood and that adequate diagnostic facilities are provided. For example, suprapubic aspiration to obtain uncontaminated urine is a technique that may well be used in an outpatient setting, and dipslide cultures are accurate and inexpensive. In addition to young age, vesicoureteric reflux and repeated attacks of pyelonephritis are risk factors associated with development of renal scarring. Therefore, diagnostic imaging to detect children with anomalies within the urinary tract are especially important in the very young. Furthermore, long-term supervision should be provided and the parents advised to consult the doctor when there is suspicion of a new infection to avoid delay in treatment. There is no reason to perform general screening for bacteriuria in healthy infants. Although bacteriuria may be found in 1 to 2 per cent, asymptomatic children have a very high rate of spontaneous clearing of the bacteriuria and they seem to constitute a low-risk group. Instead, frequent culturing of urine from febrile infants would be much more important.
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PMID:The natural history of bacteriuria in childhood. 333 55


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