Antibiotics Flashcards
Who are the individuals included in uncomplicated cystitis?
premenopausal women
first time male because of sexual activity
non pregnant women
no known urological abnormality
What are the signs and symptoms of uncomplicated cystitis
dysuria
urinary frequency
urinary urgency
suprapubic tenderness/discomfort/pressure
What symptoms indicate a complicated cystitis/pyelonephritis?
fever
flank pain
systemic symptoms
in addition to urinary sx
What bacteria are the most common cause of UTI
KEEPS:
- most commonly e.coli
K - kleibsiella
E- e.coli
E - enterobacter/enterococcus
P - proteus mirabilis
S - staph saprophyticus
What is the first line tx for uncomplicated cystitis & what is a second and third line agent
- 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
What criteria of pt is considered to have a complicated cystitis
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
name at least 5 risk factors for UTI
previous hx utis
sexually active women
BPH, strictures, bladder catheterization
women 25-54, rates increase with increasing age in men
women
When should you consider doing a urine culture (6)
- all complicated utis including men
women >65
pregnant women
suspected pyelonephritis
failed antibiotic treatment or persistent symptoms
recurrent uti
When do you not need a cultue
- women symptomatic <65
- asymptomatic bacteriuria in elderly or those with indwelling catheters
When should you investigate for anatomical or functional abnormalities for children and adults
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
First line treatment for complicated cystitis or pyelonephritis outpt
1 g ceftroiaxone or 1 dose gentamycin IV then 10 d of amoxi-clav/cefixime/septra OR cipro for 7 days
first line tx for complicated cystitis or pyelonephritis inpt
ceftriaxone or gentamicin
first line treatment for gonorrhea
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
first line treatment for chlamydia
doxycycline 100 mg PO BID x 7d OR azithromycin 1 g PO single dose if difficult for pt to have 7d course
What type of precautions do you have to tell a patient diagnosed with chlamydia or gonorrhea
do not resume intercourse until treatment is complete (7 day course OR wait 7 days, meaning you can resume on day 8)
What are the distinguishing differences between erysipelas and cellulitis?
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
What is the first line treatment for cellulitis and erysipelas
Cellulitis: cephelexin or cefadroxil 5-10 d OR IV cefazolin
Erysipelas: GAS - penicillin V or amoxicillin
what oral antibiotics can be used to treat MRSA skin and soft tissue infections
clindamycin
doxycycline
septra
minocycline
linezolid
What parenteral antibiotics can be used to treat MRSA skin and soft tissue infections?
vancocmycin
daptomycin
linezolid
For purulent skin infections, when can you consider not treating with antibiotics
1 abscess, <2 cm, no systemic sx, otherwise completely healthy, no surrounding cellulitis
What are the common pathogens that cause purulent skin infections
MRSA (staph), GAS, GBS, GCS, GGS
What are the three classifications of impetigo
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
When would you consider getting blood cultures for impetigo?
if presentation is not classic
When would you consider treating impetigo
ALWAYS treat
What are the common pathogens for bullous and non-bullos impetigo
bullous: staph aureus
non-bullous: GAS
What is first line treatment for non-bullous or limited area of bullous?
mupirocin 2% TID topically
What is the next step of treatment for impetigo?
If failed topical or more extensive or ecthyma –> treat with cloxacillin or keflex 500 mg PO QID
What should you consider if an adult presents with bullous impetigo
HIV
