C19

Question 1

Urinary AntiSeptics?

(examples)

Answer 1

Nitrofurantoin
fosfomycin (Phosphomycine)

Question 2

What are urinary antiseptics?

Answer 2

oral drugs that are rapidly excreted into the urine and act there to suppress bacteriuria

Question 3

Nitrofurantoin MOA

Answer 3

Urinary antiseptic

Question 4

nitrofurantoin SE

Answer 4

toxicity:
1. G.I irritation
2. skin rashes
3. pulmonary infiltrates
4. neuropathies
5. hemolysis (G6PD deficiency)

Question 5

Nitrofurantoin spectrum

Answer 5

• against many urinary tract pathogens (but not Proteus or Pseudomonas)
• Resistance emerges slowly

Question 6

Nitrofurantoin pharmacokinetics

Answer 6

• Oral
• excreted in the urine (filtration and secretion)
• avoided in Renal dysfunction

Question 7

fosfomycin MOA

Answer 7

-antimetabolite inhibitor
-Inhibits bacterial cytosolic enolpyruvate
transferase –> prevents the formation of N-acetylmuramic
acid (essential precursor molecule for peptidoglycan chain formation)

bactericidal

Question 8

fosfomycin pharmacokinetic

Answer 8

oral, parenteral
excreted by kidney ( with urinary conc. exceeding MIC for most UT pathogens)

Question 9

fosfomycin resistance mech

Answer 9

Resistance to fosfomycin occurs via decreased intracellular
accumulation of the drug.

Question 10

fosfomycin SE

Answer 10

• diarrhea and resistance occur with multiple dosing

Question 11

fosfomycin spectrum

Answer 11

gram +
gram -

Question 12

fosfomycin clinical use

Answer 12

uncomplicated lower UTI in women (oral, single dose)

Question 13

Acute cystitis in women treatment

Answer 13

• Nitrofurantoin oral
• TMP/SMX oral

2nd line: amoxicillin, ciprofloxacin, cefazolin

Question 14

Acute cystitis in men

Answer 14

TMP/SMX oral
Ciprofloxacin oral

Question 15

pyelonephritis uncomplicated

Answer 15

Ciprofloxacin oral/I.V
TMP/SMX oral/i.v

Question 16

pyelonephritis COMPLICATED

Answer 16

ceftriaxone I.V +/- ampicillin IV

or 2nd line : gentamycin +/- ampicillin IV

Question 17

pyelonephritis pseudomonas risk factors

Answer 17

Ceftazidime IV +/- ampicillin

Tobramycin oral
or ciprofloxacin IV

Question 18

PID

Answer 18

clindamycin I.V or gentamycin oral

2nd: ceftriaxone IV, metronidazole oral/I.V