ch 76

Question 1

What are the characteristic inflammatory syndromes that result from bacteria invading tissues of the urinary tract

Answer 1

Urethritis
Cystitis
pyelonephritis
prostatitis

Question 2

Cystitis and urethritis are considered ______ tract infections

Answer 2

lower

Question 3

pyelonephritis is considered an __________ tract infection

Answer 3

upper

Question 4

A UTI associated with a predisposing factor such as calculi, prostatic hypertrophy, indwelling catheter or urinary obstruction are considered (men or women)

Answer 4

complicated

Question 5

Uncomplicated UTIs occur primarily in who?

Answer 5

women of childbearing age and are not associated with any predisposing factors

Question 6

antibiotic classes to treat UTIs

Answer 6

sulfonamides
tirmethoprim
prnicillins
aminoglycosides
carbapenems
cephalosporins
fluoroquinolones

Question 7

2 urinary tract antiseptics

Answer 7

nitrofurantoin

methenamine

Question 8

More than 80% of uncomplicated UTIs are caused by what bacteria

Answer 8

E.coli

Question 9

what are other potential UTI causes that are gram neg bacilli

Answer 9

Klebsiella pneumoniae
Enterobacter
Proteus
Providencia
Pseudomonas species

Question 10

What is one gram positive cocci that account for 10-15% of community associated infections

Answer 10

stapylococcus saprophyticus

Question 11

Hospital associated UTIS are frequently caused by

Answer 11

Klebsiella
proteus
enterbacter 
pseudomonas species
staphylococci
enterococci
E.coli is is responsible for less than 50% of HA UTIS

Question 12

clinical manifestations of acute cystitis

Answer 12

dysuria
urgency
frequency
suprapubic discomfort
pyuria
bacteriuria

Question 13

for community associated acute cystitis, what 3 types of oral therapy can be employed?

Answer 13

1) single dose therapy
2) short-course therapy (3 days)
3) conventional therapy (7 days)

Question 14

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?

Answer 14

single-dose and short course - short course is preferred because it is more effective

Question 15

conventional therapy is indicated for all patients who do not meet the criteria for short-course therapy who include

Answer 15

males
children
pregnant women
women with suspected Upper tract involvement

Question 16

for uncomplicated cystitis what are your drugs of choice

Answer 16

trimethoprim/sulfamethoxazole

Nitrofurantoin

Question 17

In communities where resistance to the drugs of choice (>20%) what is your next line of treatment for uncomplicated cystitis?

Answer 17

fluoroquinolones (ciprofloxacin)

Question 18

what is the one dose treatment for Uncomplicated cystitis when compliance is a concern?

Answer 18

fosfomycin

Question 19

acute uncomplicated pyelonephritis is an infection of the

Answer 19

kidneys

Question 20

clinical manifestations of acute uncomplicated pyelonephritis

Answer 20

fever
chills
severe flank pain
dysuria
frequency
urgency
pyuria
bacteriuria

Question 21

treatment of mild to moderate uncomplicated pyelonephritis

Answer 21

treated at home with oral abx
fluroquinolones
trimethoprim/sulfamethoxazole

Question 22

treatment of severe pyelonephritis

Answer 22

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

Question 23

complicated UTIs occur in

Answer 23

males and females who have a structural or functional abnormality of the urinary tract that predisposes them to developing infection

Question 24

duration of treatment for a complicated UTI

Answer 24

7 days (cystitis)
14 days (pyelonephritis or with systemic involvement)

Question 25

what is caused by recolonization with the same organism responsible for the initial infection

Answer 25

relapse

Question 26

what is caused by recolonization with a new organism

Answer 26

reinfection

Question 27

more than 80% of recurrent UTIs in female are due to

Answer 27

reinfection

Question 28

when reinfections are frequent (3+ per year) long term _______may be indicated

Answer 28

prophylaxis

Question 29

what meds are used for prophylaxis

Answer 29

trimethoprim (100mg) nitrofurantoin (50 or 100 mg) trimethoprim/sulfamethoxazole (40mg/200mg)

Question 30

prophylaxis should continue for at least

Answer 30

6 months

Question 31

what can you do if reinfection is r/t intercourse

Answer 31

void after intercourse | single dose prophylaxis of trimethoprim/sulfamethoxazole 80mg/400mg) taken after intercourse

Question 32

acute bacterial prostatitis

Answer 32

inflammation of the prostate caused by local bacterial infection

Question 33

clinical manifestations of acute bacterial prostatitis

Answer 33

``` high fever chills malaise myalgia localized pain various urinary tract symptoms ```

Question 34

for severe infection of acute bacterial prostatitis with E coli causing acute bacterial prostatitis

Answer 34

start with an iv agent (a fluoroquinalone (ie)ciprofloxacine) followed by 2-4 weeks with an oral agent (either doxycycline or a fluoroquinolone)

Question 35

treatment for severe infection of acute bacterial prostatitis with vancomycin - sensitive E faecalis

Answer 35

start with iv ampicillin/sulbactam | followed by 2-4 weeks with oral amoxicillin, levofloxacin or doxycycline

Question 36

what is the first choice drug for uncomplicated cystitis?

Answer 36

Nitrofurantoin

Question 37

what are the trade names for Nitrofurantoin

Answer 37

Furandantin Macrodantin Macrobid

Question 38

Nitrofurantoin (Macrobid) is active against a large number of what type of bacteria

Answer 38

gram-positive gram negative ``` staphylococci streptococci Neisseria Bacteroides strains of E coli ```

Question 39

what organisms are frequently resistant to Macrobid

Answer 39

Proteus Pseudomonas enterobacter klebsiella

Question 40

therapeutic use for Nitrofurantoin (Macrobid)

Answer 40

infections of the lower urinary tract prophylaxis of recurrent lower UTI not recommended for infections of upper UTI

Question 41

adverse effects of Macrobid

Answer 41

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

Question 42

how do you minimize GI upset with macrobid

Answer 42

take with food or milk

Question 43

macrobid and newborns

Answer 43

contraindicated

Question 44

macrobid in preganant women

Answer 44

contraindicated

Question 45

antimicrobial spectrum of methenamine (Hiprex, Urex)

Answer 45

virtually all bacteria are susceptible to this med, virtually no resistance

Question 46

Methenamine (Hiprex, Urex) is used for

Answer 46

chronic infection of the Lower urinary tract

Question 47

Uncomplicated acute cystitis allergic to sulfa or nitro or renal dysfunction allergic to beta lactam antibiotics or known resistance

Answer 47

Fluoroquinolone | Ciprofloxacin or Levofloxacin

Question 48

Uncomplicated acute cystitis allergic to sulfa or nitro or renal dysfunction No allergy to beta lactam abx or known resistance

Answer 48

Augmentin Cephalexin seeing community resistance now

Question 49

what do you treat infants with uti

Answer 49

ampicillin and gentamycin

Question 50

can you give nitrofurantoin in infants

Answer 50

not less than 1 month