C.19. Nitrofurantoin. Fosfomycine. Pharmacotherapy of UTI's Flashcards
what drug has a metronidazole like structure?
Nitrofurantoin
what is Nitrofurantoin classified as?
Urinary antiseptic
it’s an oral drug that is rapidly excreted into the urine and acts there to suppress bacteriuria. acts only in the urinary tract and accumulates in the Urine
what does Nitrofurantoin lack?
systemic antibacterial effects
what is Nitrofurantoin used for?
- treatment of uncomplicated lower UTI’s
2. against urinary tract pathogens (not proteus and pseudomonas)
what enhances the activity of Nitrofurantoin?
urine acidification
what type of elimination do Nitrofurantoin and Fosfomycin have?
renal elimination
side effects of Nitrofurantoin
common in prolonged use or in renal impairment:
- GI distress
- skin rash
- pulmonary infiltrate
- phototoxicity
- acute hemolysis in G6PD deficient patients
how does Fosfomycin work?
Bactericidal effect
inhibits the bacterial enzyme enolpyruvate transferase–> blocking the synthesis of N-acetylglucosamine (precurser of bacterial cell wall synthesis)
how is Fosfomycin given?
oral single dose 3g
*there’s also parenteral
what is Fospfomycin used for?
gram + and gram -
treatment of uncomplicated lower UTI’S in women
E.coli
staph.aureus
a side effect of fosfomycin
diarrhea
1st line treatment of acute cystitis in women
Nitrofurantoin PO and TMP-SMX PO
alternative choice for treatment in acute cystitis in women
Amoxicillin PO or Ciprofloxacin PO or Cefazolin PO
1st line treatment of acute prostatitis in men
TMP-SMX PO or Ciprofloxacin PO
1st line treatment of uncomplicated pyelonephritis
Ciprofloxacin PO/IV
TMP-SMX PO/IV
