Talk:Pyelonephritis

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[edit] Trimethoprim

Trimethoprim is NOT a suitable treatment for pyelonephritis. Although it works very well for cystitis when the causative bacterium is susceptible, it cannot work when the kidney is infected in cases of pyelonephritis. This is because it acts to block folic acid synthesis in bacteria. The bloodstream, which supplies the kidney, is a rich source of folic acid. Any bacteria that are present in the kidney are supplied with folic acid, overcomimg the block imposed by trimethoprim. The same is true for the combination of trimethoprim and a sulphonamide (co-trimoxazole): sulphonamides also act to block bactieral folic acid synthesis.

Micjh

Still according to PMID 10589881 it is an acceptable alternative to fluoroquinolone for susceptible organisms. --WS 20:23, 8 January 2006 (UTC)

From Trimethoprim: Bacteria are unable to take up folic acid from the environment (i.e. the infection host) thus are dependent on their own de novo synthesis - inhibition of the enzyme starves the bacteria of two bases necessary for DNA replication and transcription. So folic acid from the blood is no good for them. --WS 20:28, 8 January 2006 (UTC)

  • In our area we tend to use cefalosporins for pyelonephritis with systemic symptoms (e.g. fever, rigors, lassitude). With the most common cause being coliforms one could certainly make a case for trimethoprim, but rapidly progression urosepsis usually makes clinicians choose a broader spectrum, which may include ceph or fluoroquinolones. We seem to be growing a lot of trimethoprim-resistant coli strains around here these days. JFW | T@lk 21:09, 8 January 2006 (UTC)

[edit] PBC

The article suggested that PBC was a predisposing state for pyelonephritis. Searching PubMed I can only find some Japanese case reports that suggest the coliforms cause PBC through molecular mimicry, but nothing on an increase of UTIs. It bears noting that PBC is often treated with immunosuppression, and that this independently increases the risk for UTIs. JFW | T@lk 20:52, 25 July 2007 (UTC)