Case 2 – Urinary tract infection

Question 1

General info - no need to memorize…

Answer 1

A 71 year old female is admitted to the hospital because of fever, chills, dysuria, and flank pain.

Question 2

What is the probable diagnosis?

Answer 2

Pyelonephritis

Question 3

is caused by? - 5

Answer 3

bacteria from the GI tract (E. Coli, Klebsiella pneumonia, Proteus mirabilis, less commonly enterococci, pseudomonas)

Question 4

Tx. of Pyelonephritis - 5

Answer 4

Penicillin + beta lactamase inhibitors 
3rd and 4th generations Cephalosporins
Carbapenems
Aminoglycosides
Fluoroquinolones

Question 5

Penicillins

Answer 5

by themselves are no longer an option – almost always resistant – must be given w/ inhibitor

Question 6

Fluoroquinolones - advantages - 3

Answer 6

oral form, good absorption and few SEs

Question 7

Fluoroquinolones - types - 3

Answer 7

Ciprofloxacin, ofloxacin – mainly for Gram negative

Levofloxacin – respiratory quinolone – good activity against Streptococcus pneumonia

Question 8

Fluoroquinolones - side effects - 3

Answer 8

rare, relatively safe - QT elongation, rupture of Achilles tendon, cartilage damage (Previously contraindicated in children)

Question 9

Aminoglycosides - pros - 2

Answer 9

covers nearly all Gram negative bacteria - Urinary excretion excellent for UTIs.

Question 10

Aminoglycosides - cons - 4

Answer 10

only in IV form, very nephrotoxic, ototoxic, req monitoring

Question 11

Penicillin + beta lactamase inhibitors - types - 2

Answer 11

ampicillin+clavulonic acid= (augmentin) active for Gram negative Gram positive and anaerobes

pipercillin+tazobactam =(tazocin) – same but also Pseudomonas!

Question 12

3rd and 4th generations Cephalosporins - types - 2

Answer 12

Ceftriaxone (rocephin) 3rd gen mainly for Gram negative

Ceftazidime (fortum) – 4th gen – mainly Gram negative but also Pseudomonas.

Question 13

3rd and 4th generations Cephalosporins - side effects

Answer 13

similar to penicillin. Around 1-5% cross reactivity in penicillin allergy. May use in patients with NON IgE-mediated reaction (pulm edema) to penicillin meaning: if a patient has a light allergy to Penicillin (rash etc.) you can give Cephalosporins

Question 14

Carbapenems - types - 4

Answer 14

Imipenem, Meropenem, Doripenem – broad spectrum Gram neg and pseudomonas

Ertapenem – good for Gram neg, not good for Psedomonas

Question 15

Carbapenems - spectrom?

Answer 15

Advantage: extremely broad spectrum (good when bac unknown)
Disadvantage: extremely broad spectrum (bad for general resistance)