Davis UTI abx

Question 1

Risk factors for UTI

Answer 1

Sex
Spermicides
Structural abnormalities
Neurogenic bladder (SCI, stroke)
Immunosuppression (HIV, DM)
Catheterization

Question 2

Common Cystitis infection

Answer 2

Increased urinary frequency
Urgency
Dysuria
Pain above pubic region
WBC & bacteria in urine
Hematuria (possible)

Question 3

Urinalysis findings

Answer 3

Bacteria - High specificity

Pyuria: Leukocyte esterase - High sensitivity
WBC>10 - High sensitivity

Nitrite - specific

Hematuria - specific
Common in UTI, not urethritis or vaginitis

Epithelial cells indicate contamination

Question 4

UTI treatment

Answer 4

Trimethoprim-sulfamethoxazole

Nitrofurantoin
Fosfomycin
Ciprofloxacin

Phenazopyridine

Question 5

TMP-SMX

Answer 5

Bactrim

binds bacterial folate reductase more than human

Hydration to prevent crystals (metabolite of sulfamethoxazole)

Avoid in 3rd trimester

Avoid if sulfa allergy

Adverse: GI distress, Stevens-Johnson syndrome, Megaloblastic anemia

Question 6

Nitrofurantoin

Answer 6

Rapidly excreted in the urine

Bacteria convert drug to active metabolite that damage bacterial DNA and ribosomal proteins
Mammalian much more slowly

Turns urine brown

Adverse: GI distress, HA

Question 7

Fosfomycin

Answer 7

Excreted in urine and feces unchanged

Blocks 1st steps of cell wal peptidoglycan synthesis
(irreversibly inhibits enolpyruvyl transferase)

Adverse: GI distress, HA

Question 8

Ciprofloxacin

Answer 8

Fluoroquinolone

Inhibits DNA gyrase and type IV topoisomerase

Avoid in children and Pregnancy

GI distress, tendonitis, phototoxicity, prolonged QT interval

Question 9

Phenazopyridine

Answer 9

Analgesic effect on urinary tract

azo dye so urine will be orange/red

Question 10

Treatment for Recurrent UTI

Answer 10

Low dose, daily
or
Single postcoital dose

Question 11

Pyelonephritis sx and tx

Answer 11

Flank Pain
High Fever

Malaise, cystitis like sx

Ciprofloxacin

Question 12

Prostatitis sx and tx

Answer 12

Uncomplicated with low risk of STD - E. coli

Pain in lower back
High fever
Chills
Cystitis like sx

Ciprofloxacin

Question 13

Renal Abscess

Answer 13

Pyelonephritis -> E. coli
Bacteremia -> S. aureus

Over 5cm then drain

E. coli - Piperacillin + Tazobactam

S. aureus - Nafcillin
MRSA - Vancomycin

Question 14

Renal abscess E. coli

Answer 14

Piperacillin + Tazobactam

PIP: extended spectrum penicillin inhibits cell wall syntehsis

TZ: inhibits B-lactamase

Question 15

Renal Abscess S. aureus

Answer 15

Nafcillin

penicillinase-resistant penicillin inhibits cell wall synthesis

MRSA- Vancomycin

Question 16

Urethritis

Neisseria gonorrhoeae

Answer 16

Ceftriaxone + Azithromycin

Ceftriaxone: 3rd gen cephalosporin, inhibits cell wall synthesis

Azithromycin: Macrolide
Inhibits bacterial protein synthesis (50s)

Question 17

Urethritis

Chlamydia trachomatis

Answer 17

Azithromycin
Macrolide
Inhibits bacterial protein synthesis (50s)

Question 18

Piperacillin + Tazobactam

Answer 18

Renal E. coli abscess

PIP: extended spectrum penicillin inhibits cell wall syntehsis

TZ: inhibits B-lactamase

Adverse: GI distress, yeast infection

Question 19

Ceftriaxone

Answer 19

Neisseria gonorrhoeae urethritis

Ceftriaxone: 3rd gen cephalosporin, inhibits cell wall synthesis

Cef+azithro

Adverse: Hypersensitivity, Yeast infection cross-sensitivity with penicillins

Question 20

Nafcillin

Answer 20

Renal Abscess S. aureus

Adverse: GI distress, hypersensitivity

Question 21

Vancomycin

Answer 21

Renal Abscess MRSA

Adverse: Nephrotoxic, Ototoxic, Rash on face/upper torso