22: UTI Treatment - Henry

Question 1

which of the following agents inhibits DNA synthesis?
ciprofloxacin
levofloxacin
fosfomycin
TMP-SMX
nitrofurantoin

Answer 1

TMP-SMX inhibit purine synthesis

cell wall synthesis - fosfomycin

DNA gyrase and topoisomerase - ciprofloxacin and levofloxacin

Question 2

which bacteria are most often associated with uncomplicated UTI?

Answer 2

e. coli

other gram neg would be second most common

Question 3

cystitis v. pyelonephritis

Answer 3

cystitis: dyuria, increased frequency of urination, WBC and bac in urine, hematuria, no fever*
pyelonephritis: *flank pain, * fever, and the cysitis s/s

Question 4

complicated v. uncomplicated cystitis

Answer 4

complicated essentially has something else including DM, deformity, other health issue etc

could have impaired sensation, resistance,

Question 5

1st line agents for uncomplicated cystitis

Answer 5

nitrofurantoin (bacterial reduction of compound to generate DNA damaging intermediate)

TMP-SMX (disrupt folate metabolism)

Fosfomycin (cell wall synthesis inhibitor)

Question 6

2nd line agents for uncomplicated cystitis

Answer 6

ciprofloxacin/levofloxacin (DNA replication inhibitor by binding gyrase and topoisomerase) – less efficacious, ecological effects, resistance)

amoxicillin (cell wall synthesis inhibitor) – less efficacious, resistance, mild adverse effects

Question 7

1st line agents for uncomplicated pyelonephritis

Answer 7

ciprofloxacin/levofloxacin (fluoroquinolone) (DNA replication inhibitor by binding gyrase and topoisomerase) *highest efficacy

TMP-SMX (disrupt folate metabolism)(don’t use with high E. coli resistance)

Question 8

2nd line agents for uncomplicated pyelonephritis

Answer 8

amoxicillin (cell wall synthesis inhibitor)

ceftriaxone and cefuroxime (cell wall synthesis inhibitor)

Question 9

strongest risk factor for uncomplicated UTIs

Answer 9

sexual intercourse

Question 10

women with previously diagnosed cystitis can accurately self-diagnose subsequent cystitis in more than ________ of cases and can successfully treat themselves

Answer 10

85-95%

write a script and have them fill as needed

Question 11

fluoroquinolones such as _______- are not first line agents for tx of uncomplicated cystitis but are used for uncomplicated pyelonephritis

Answer 11

ciprofloxacine or levofloxacin