GU and Mens Health pt.2 Flashcards
Causes of Epididymitis, Orchitis, Prostatitis and Urethritis?
Mostly bacterial
Viral and fungal possible
Urinalysis usually provides answers like?
C&S takes time (24 - 48 hours)
Empirical treatment based o H&P
Orchitis follows ________.
epididymitis
Epididymitis and Orchitis mostly in men how old?
Men 14 to 35 years old
Epididymitis and Orchitis common pathogens?
Neisseria Gonorrhoeae and
Chlamydia trachomatis
Epididymitis and Orchitis: older and younger pathogen?
e. coli
especially catheter patients
Obtain culture and sensitivity with ?
urethral swab
Epididymitis and Orchitis tx?
Suspected GC or Chlamydia infections
Rocephin 250 mg IM single dose and
azithromycin (Zithromax) 1 gram PO
or
Doxycycline (Vibramycin) 100 mg twice daily for 10 days
outpatient
If enteric infection suspected? what pathogens?
Escherichia coli
Klebsiella spp.
Enterobacter spp
If enteric infection suspected
what is tx?
fluoroquinolones
ofloxacin 300 mg by mouth twice a day for 10 days or
levofloxacin 500 mg by mouth once daily for 10 days
resistance is a big problem with these drugs
Urinary Tract Infections specimens ?
Voided clean catch specimens
When it affects the lower urinary tract it is known as a____________.
bladder infection(cystitis)
When it affects the upper urinary tract it is known as____________.
kidney infection (pyelonephritis)
Symptoms from a lower urinary tract infection
pain withurination (dysuria) - H ion on tip of urethra
frequent urination
feeling the need to urinate despite having an empty bladder (urgency)
Symptoms of a kidney infection?
feverandflank pain(CVA tenderness) usually in addition to the symptoms of a lower UTI.
Urinary Tract Infections
most common cause of infection is ?
Escherichia coli (E-coli)
risk factors for UTI?
female anatomy - less complete emptying
sexual intercourse
Incomplete emptying / lack urination
Obesity
catheter
Although sexual intercourse is a risk factor, UTIs are not classified as_______.
sexually transmitted infections(STIs)
**STI’s can mimic UTI’s sometimes so be careful **
Kidney infection usually follows a bladder infection but may also result from a__________,
bacteremia blood infection
UTI tx?
UTIs are treated with a short course ofAbx
UTI ABS?
Nitrofurontin
TMP/SMZ
Cephalexin
Resistance high to many of the antibiotics used i.e. Ciprofloxacin
complicated cases of UTI tx?
longer course orIVantibiotics
Phenazopyridine (Pyridium) may help with symptoms
GIVES SOME RELIEF with uncomplicated UTI until C&S comes back
Pyelonephritis Tx?
Ceftriaxone
Pyelonephritis facts?
Out patient longer therapy
Bacteriogram (local resistance patterns)
Urine cultures for complicated, recurrent or bacteremia
dirty urine with stone - treat them aggressively cause it can back up and kill the kidney , dont get lost in a fever, sometimes the fever means nothing when it comes to kidney
Ceftriaxone (Rocephin) class?
Cephalosporin, 3rd generation
**can use even if PCN allergy cause extremely low cross over **
Ceftriaxone (Rocephin)
MOA?
bactericidal; inhibits cell wall mucopeptide synthesis
azithromycin (Zithromax)
class?
Macrolides
azithromycin (Zithromax)
MOA?
binds to 50S ribosomal subunit, inhibiting protein synthesis
azithromycin (Zithromax)
adverse rxn?
Caution QT-prolongation
doxycycline (Vibramycin)
class?
Tetracyclines
doxycycline (Vibramycin)
MOA?
Mechanism of Action bacteriostatic; binds to 30S and possibly 50S ribosomal subunit(s), inhibiting protein synthesis
doxycycline (Vibramycin)
adverse rxn?
Doxycycline can cause permanent yellowing or graying of the teeth in children younger than 8 years old.
Levofloxacin (Levaquin)
class?
Fluoroquinolones
Levofloxacin (Levaquin)
MOA?
bactericidal; inhibits DNA gyrase and topoisomerase
Levofloxacin (Levaquin)
BBW?
Tendinitis/Tendon Rupture assoc. w/ incr. tendinitis/tendon rupture risk in all ages; risk further incr. in older pts >60 yo,
Avoid in Myasthenia Gravis fluoroquinolones may exacerbate muscle weakness in pts w/ myasthenia gravi
Acute prostatitis generally caused by the same organisms that cause ?
UTI
Most commonly gram-negative bacteria, especially ?
Enterobacteriaceae (typically Escherichia coli or Proteus species).
Sexually transmitted pathogens, such as ___________ and _______________, are possible etiologies in sexually active men, who may have concomitant urethritis or epididymitis
Neisseria gonorrhoeae
Chlamydia trachomatis
Patients with acute bacterial prostatitis are typically acutely ___.
ill
A urine Gram stain and culture should be obtained in all men suspected of _____________ to identify the bacterial etiology
having acute prostatitis
Prostatitis then think?
Think HIV, immunocompromised
especially in young man with prostatitis
Prostatitis tx?
Treatment with trimethoprim-sulfamethoxazole (Bactrim) or a fluoroquinolone (Levaquin), unless drug resistance is suspected.
Longer treatment 4 to 12 weeks
Prostatitis IV ampicillin therapy if?
sepsis or co-morbidities
trimethoprim/ sulfamethoxazole (Bactrim)
class?
Sulfonamides
trimethoprim/ sulfamethoxazole (Bactrim)
MOA?
Selectively inhibits dihydrofolate reductase (folate antagonist) and sulfamethoxazole competes with para-aminobenzoic acid (PABA), inhibiting folic acid synthesis
trimethoprim/ sulfamethoxazole (Bactrim)
caution if ?
Sulfur allergy
methemoglobinemia
photosensitivity
ampicillin/ sulbactam (Unasyn) class?
Penicillins
IV therapy
ampicillin/ sulbactam (Unasyn) MOA?
bactericidal; inhibits cell wall mucopeptide synthesis / inhibits beta-lactamases
ampicillin/ sulbactam (Unasyn) caution / interaction?
alters GI flora
bactericidal activity requires bacterial growth
lowers seizure threshold
