Antibiotics

Question 1

Who are the individuals included in uncomplicated cystitis?

Answer 1

premenopausal women
first time male because of sexual activity
non pregnant women
no known urological abnormality

Question 2

What are the signs and symptoms of uncomplicated cystitis

Answer 2

dysuria
urinary frequency
urinary urgency
suprapubic tenderness/discomfort/pressure

Question 3

What symptoms indicate a complicated cystitis/pyelonephritis?

Answer 3

fever
flank pain
systemic symptoms
in addition to urinary sx

Question 4

What bacteria are the most common cause of UTI

Answer 4

KEEPS:
- most commonly e.coli
K - kleibsiella
E- e.coli
E - enterobacter/enterococcus
P - proteus mirabilis
S - staph saprophyticus

Question 5

What is the first line tx for uncomplicated cystitis & what is a second and third line agent

Answer 5

• 1st: macrobid (nitrofurantoin) 100 mg PO BID x 5-7 d OR septra 1 DS tablet PO BID x 3 d
• 2nd:
  – cephalexin 250-500 mg QID x 7d
  –Cipro 500 mg PO BID x 3 d
  –Fosfomycin 3 g PO x 1 dose

Question 6

What criteria of pt is considered to have a complicated cystitis

Answer 6

pregnant women
immunosuppressed (DM, PCKD, other)
functional abnormalities (stones, strictures, neurogenic bladder)
hx of urinary tract instrumentation (catheters, ureteric stents)
Renal failure
most infections in men

Question 7

name at least 5 risk factors for UTI

Answer 7

previous hx utis
sexually active women
BPH, strictures, bladder catheterization
women 25-54, rates increase with increasing age in men
women

Question 8

When should you consider doing a urine culture (6)

Answer 8

• all complicated utis including men
  women >65
  pregnant women
  suspected pyelonephritis
  failed antibiotic treatment or persistent symptoms
  recurrent uti

Question 9

When do you not need a cultue

Answer 9

• women symptomatic <65
• asymptomatic bacteriuria in elderly or those with indwelling catheters

Question 10

When should you investigate for anatomical or functional abnormalities for children and adults

Answer 10

diagnosis of pyelonephritis
child w/ first uti at <2 yo
child of any age with recurrent utis
fam or personal hx of urologic or renal abnormalities

Can use renal u/s or CT (preferred) in adults to assess complicating anatomic or physiologic factors in pt with persistent symptoms despite 48-72 h of antibiotic therapy

Question 11

First line treatment for complicated cystitis or pyelonephritis outpt

Answer 11

1 g ceftroiaxone or 1 dose gentamycin IV then 10 d of amoxi-clav/cefixime/septra OR cipro for 7 days

Question 12

first line tx for complicated cystitis or pyelonephritis inpt

Answer 12

ceftriaxone or gentamicin

Question 13

first line treatment for gonorrhea

Answer 13

ceftriaxone 250 mg IM one dose AND azithromycin 1 g PO single dose OR cefixime 800 mg PO single dose PLUS azithromycin 1 g PO single dose

Question 14

first line treatment for chlamydia

Answer 14

doxycycline 100 mg PO BID x 7d OR azithromycin 1 g PO single dose if difficult for pt to have 7d course

Question 15

What type of precautions do you have to tell a patient diagnosed with chlamydia or gonorrhea

Answer 15

do not resume intercourse until treatment is complete (7 day course OR wait 7 days, meaning you can resume on day 8)

Question 16

What are the distinguishing differences between erysipelas and cellulitis?

Answer 16

Erysipelas: light red in colour, sharp demarcation, raised border, induration, usually caused by strep

Cellulitis: less sharp demarcation, darker red/purplish in colour, affects deeper tissues, usually caused by staph

Question 17

What is the first line treatment for cellulitis and erysipelas

Answer 17

Cellulitis: cephelexin or cefadroxil 5-10 d OR IV cefazolin

Erysipelas: GAS - penicillin V or amoxicillin

Question 18

what oral antibiotics can be used to treat MRSA skin and soft tissue infections

Answer 18

clindamycin
doxycycline
septra
minocycline
linezolid

Question 19

What parenteral antibiotics can be used to treat MRSA skin and soft tissue infections?

Answer 19

vancocmycin
daptomycin
linezolid

Question 20

For purulent skin infections, when can you consider not treating with antibiotics

Answer 20

1 abscess, <2 cm, no systemic sx, otherwise completely healthy, no surrounding cellulitis

Question 20

What are the common pathogens that cause purulent skin infections

Answer 20

MRSA (staph), GAS, GBS, GCS, GGS

Question 20

What are the three classifications of impetigo

Answer 20

1) non-bullous: over 1 week, lesions go from papules to vesicles with surrounding erythema and the pustules break to form honey crusted lesions
2) bullous: mostly occurs in younger children, vesicles enlarge and form flaccid bullae, clear yellow to darker and turbid
3) ecthyma: deeper, punched lesions into dermis, surrounding erythema and yellow crust

Question 20

When would you consider getting blood cultures for impetigo?

Answer 20

if presentation is not classic

Question 20

When would you consider treating impetigo

Answer 20

ALWAYS treat

Question 20

What are the common pathogens for bullous and non-bullos impetigo

Answer 20

bullous: staph aureus
non-bullous: GAS

Question 21

What is first line treatment for non-bullous or limited area of bullous?

Answer 21

mupirocin 2% TID topically

Question 22

What is the next step of treatment for impetigo?

Answer 22

If failed topical or more extensive or ecthyma –> treat with cloxacillin or keflex 500 mg PO QID

Question 23

What should you consider if an adult presents with bullous impetigo

Answer 23

HIV