ch 76 Flashcards
What are the characteristic inflammatory syndromes that result from bacteria invading tissues of the urinary tract
Urethritis
Cystitis
pyelonephritis
prostatitis
Cystitis and urethritis are considered ______ tract infections
lower
pyelonephritis is considered an __________ tract infection
upper
A UTI associated with a predisposing factor such as calculi, prostatic hypertrophy, indwelling catheter or urinary obstruction are considered (men or women)
complicated
Uncomplicated UTIs occur primarily in who?
women of childbearing age and are not associated with any predisposing factors
antibiotic classes to treat UTIs
sulfonamides tirmethoprim prnicillins aminoglycosides carbapenems cephalosporins fluoroquinolones
2 urinary tract antiseptics
nitrofurantoin
methenamine
More than 80% of uncomplicated UTIs are caused by what bacteria
E.coli
what are other potential UTI causes that are gram neg bacilli
Klebsiella pneumoniae Enterobacter Proteus Providencia Pseudomonas species
What is one gram positive cocci that account for 10-15% of community associated infections
stapylococcus saprophyticus
Hospital associated UTIS are frequently caused by
Klebsiella proteus enterbacter pseudomonas species staphylococci enterococci E.coli is is responsible for less than 50% of HA UTIS
clinical manifestations of acute cystitis
dysuria urgency frequency suprapubic discomfort pyuria bacteriuria
for community associated acute cystitis, what 3 types of oral therapy can be employed?
1) single dose therapy
2) short-course therapy (3 days)
3) conventional therapy (7 days)
what treatment therapy is recommended for uncomplicated, community associated infections in women that are not pregnant and whose symptoms began less than 7 days before starting treatment?
single-dose and short course - short course is preferred because it is more effective
conventional therapy is indicated for all patients who do not meet the criteria for short-course therapy who include
males
children
pregnant women
women with suspected Upper tract involvement
for uncomplicated cystitis what are your drugs of choice
trimethoprim/sulfamethoxazole
Nitrofurantoin
In communities where resistance to the drugs of choice (>20%) what is your next line of treatment for uncomplicated cystitis?
fluoroquinolones (ciprofloxacin)
what is the one dose treatment for Uncomplicated cystitis when compliance is a concern?
fosfomycin
acute uncomplicated pyelonephritis is an infection of the
kidneys
clinical manifestations of acute uncomplicated pyelonephritis
fever chills severe flank pain dysuria frequency urgency pyuria bacteriuria
treatment of mild to moderate uncomplicated pyelonephritis
treated at home with oral abx
fluroquinolones
trimethoprim/sulfamethoxazole
treatment of severe pyelonephritis
hospitalization IV ABX options include ciprofloxacin ceftriaxone ceftazidime ampicillin plus gentamycin ampicillin/subactam
after you have gained control with IV abx
switch to oral abx within 24 -48 hours
complicated UTIs occur in
males and females who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection
duration of treatment for a complicated UTI
7 days (cystitis) 14 days (pyelonephritis or with systemic involvement)
what is caused by recolonization with the same organism responsible for the initial infection
relapse
what is caused by recolonization with a new organism
reinfection
more than 80% of recurrent UTIs in female are due to
reinfection
when reinfections are frequent (3+ per year) long term _______may be indicated
prophylaxis
what meds are used for prophylaxis
trimethoprim (100mg)
nitrofurantoin (50 or 100 mg)
trimethoprim/sulfamethoxazole (40mg/200mg)
prophylaxis should continue for at least
6 months
what can you do if reinfection is r/t intercourse
void after intercourse
single dose prophylaxis of trimethoprim/sulfamethoxazole 80mg/400mg) taken after intercourse
acute bacterial prostatitis
inflammation of the prostate caused by local bacterial infection
clinical manifestations of acute bacterial prostatitis
high fever chills malaise myalgia localized pain various urinary tract symptoms
for severe infection of acute bacterial prostatitis with E coli causing acute bacterial prostatitis
start with an iv agent (a fluoroquinalone (ie)ciprofloxacine)
followed by 2-4 weeks with an oral agent (either doxycycline or a fluoroquinolone)
treatment for severe infection of acute bacterial prostatitis with vancomycin - sensitive E faecalis
start with iv ampicillin/sulbactam
followed by 2-4 weeks with oral amoxicillin, levofloxacin or doxycycline
what is the first choice drug for uncomplicated cystitis?
Nitrofurantoin
what are the trade names for Nitrofurantoin
Furandantin
Macrodantin
Macrobid
Nitrofurantoin (Macrobid) is active against a large number of what type of bacteria
gram-positive
gram negative
staphylococci streptococci Neisseria Bacteroides strains of E coli
what organisms are frequently resistant to Macrobid
Proteus
Pseudomonas
enterobacter
klebsiella
therapeutic use for Nitrofurantoin (Macrobid)
infections of the lower urinary tract
prophylaxis of recurrent lower UTI
not recommended for infections of upper UTI
adverse effects of Macrobid
anorexia
n/v/d
dyspnea chest pain chills fever cough
leukopenia
hemolytic anemia - gpd6 and in newborns
demyelination and nerve degeneration
muscle weakness
tingling
severe liver injury - manifests as
hepatitic necrosis
cholestatic jaundice
how do you minimize GI upset with macrobid
take with food or milk
macrobid and newborns
contraindicated
macrobid in preganant women
contraindicated
antimicrobial spectrum of methenamine (Hiprex, Urex)
virtually all bacteria are susceptible to this med, virtually no resistance
Methenamine (Hiprex, Urex) is used for
chronic infection of the Lower urinary tract
Uncomplicated acute cystitis
allergic to sulfa or nitro or renal dysfunction
allergic to beta lactam antibiotics or known resistance
Fluoroquinolone
Ciprofloxacin or Levofloxacin
Uncomplicated acute cystitis
allergic to sulfa or nitro or renal dysfunction
No allergy to beta lactam abx or known resistance
Augmentin
Cephalexin
seeing community resistance now
what do you treat infants with uti
ampicillin and gentamycin
can you give nitrofurantoin in infants
not less than 1 month
