Exam 2: Antimicrobial Therapy DSA

Question 1

• understand what Uncomplicated means
• define recurrent (for acute UTIs)

Answer 1

• Uncomplicated
  
  • means there is no structural abnormality in these patients.
    
    • cystitis, urethritis
• _*Recurrent_
  
  • defined as 3 or more episodes a year
  • or 2 or more episodes in 6 months.

Question 2

Acute Uncomplicated UTI

(no risk factor for STD)

• Common organisms
• Primary Tx

Answer 2

Acute Uncomplicated UTI

• Most common organisms
  
  • E. coli, S. saprophyticus, p. mirabilis, K. pneuomoniae
• Primary Therapy
  
  • TMP/SMX or ciprofloxacin or levofloxacin
• 20% of E. coli is resistant to this antibiotic
  
  • depending on your region, you may have to pick another antibiotic
    
    • nitrofurantoin
• If sulfa allergy
  
  • nitrofurantoin or fosfomycin

Question 3

Recurrent Acute Uncomplicated UTI

• Common organisms
• Primary Tx

Answer 3

Recurrent Acute Uncomplicated UTI

• Most common organisms
  
  • E. coli, Staph saprophyticus, enterococci, C. trachomatis
• Primary Therapy
  
  • eradicate infection using scale above (risk of STD or not)
• Secondary Prophylactic therapy
  
  • TMP/SMX OR cephalexin** OR Ciprofloxacin**
• Recurrent UTI is defined as
  
  • >3 cultures and symptomatic UTI in 1 year or 2 UTI in 6 months

Question 4

• understand Complicated vs Uncomplicated means
• Sx for female vs male

Answer 4

• Uncomplicated
  
  • means there is no structural abnormality in these patients.
    
    • cystitis, urethritis
• Complicated
  
  • means there is a structural abnormality
  • or the patient has a urinary catheter.
• Usually women
  
  • 18-40 years old, temperature > 102 F, definite costovertebral tenderness, pain, nausea/vomiting.
• If male
  
  • look for obstructive uropathy or other complicating pathology.

Question 5

Acute Uncomplicated pyelonephritis

Outpatient

• Common organisms
• Primary Tx

Answer 5

Acute Uncomplicated pyelonephritis - Outpatient

• Suspected organisms
  
  • E. coli (75-95%), P. mirabilis, K. pneumoniae, S. saprophyticus
• Primary Therapy
  
  • ciprofloxacin or levofloxacin

Question 6

Acute Uncomplicated pyelonephritis

Inpatient

• Common organisms
• Primary Tx

Answer 6

Acute Uncomplicated pyelonephritis - Inpatient

• Suspected organisms
  
  • E. coli (75-95%), P. mirabilis, K. pneumoniae, S. saprophyticus
• Primary Therapy
  
  • Ceftriaxone, levofloxacin, ciprofloxacin, moxifloxacin, or meropenem

Question 7

Complicated UTI / catheters

• Common organisms
• Primary Tx

Answer 7

Complicated UTI / catheters

• Suspected organisms
• E. coli or other Enterobacteriaceae, P. aeruginosa, enterococci, S. aureus, candida
• If low risk of Multi-drug resistant gram negative bacteria
  
  • Levofloxacin, ceftriaxone, cefepime, piperacillin/tazobactam, gentamicin, aztreonam
• If high risk of multi-drug resistant gram negative bacteria (>20%)
  
  • meropenem, ceftolozane/tazobactam, or ceftazidime/avibactam

Question 8

Acute Pyelonephritis - Pregnancy

• Primary Tx

Answer 8

Acute Pyelonephritis - Pregnancy

• Treat 10-14 days
• Moderately ill
  
  • Ceftriaxone, cefepime, or aztreonam (If penicillin allergic)
• Secondary prophylaxis
  
  • required for duration of pregnancy
  • Nitrofurantoin or cephalexin

Question 9

asymptomatic bacteriuria**

Answer 9

• Normally, we don’t treat asymptomatic bacteriuria**.
• However, there are a few exceptions to that rule.
  
  • If a patient is pregnant
    
    • we need to treat the patient.
    • You would also continue to screen monthly for recurrence.
    • Most clinicians continue to treat the patient until pregnancy is over.

Question 10

Asymptomatic bacteriuria**

in pregnant patients

• Common organisms
• Primary Tx

Answer 10

Asymptomatic bacteriuria** in pregnant patients

• Suspected organisms
  
  • aerobic gram-negative bacilli and Staph hemolyticus
• Primary Therapy
  
  • nitrofurantoin (but not in first trimester), amoxicillin/clavulanate, OR cephalexin
• Alternative therapy
  
  • TMP/SMX OR cefpodoxime

Question 11

Asymptomatic bacteriuria**

Before and after invasive urologic intervention

• Common organisms
• Primary Tx

Answer 11

Asymptomatic bacteriuria** - invasive urologic intervention

• Suspected organism
  
  • aerobic gram negative bacilli
• Primary Therapy
  
  • TMP/SMX