Lecture 17.1: Genitourinary Infections Flashcards
What are some of the common Genitourinary System Infections?
- Pyelonephritis: Kidney Infections
- Cystitis: Bladder Infection
- Urethritis: Urethra Infection
- Prostatitis: Prostate Infection [Males]
- Epidiymitis: Epididymis Infection [Males]
What are the Classifications of UTIs?
- Asymptomatic Bacteriuria [DO NOT TREAT]
- Uncomplicated
- Complicated
- Pyelonephritis
- Catheter-Associated
ASB - ONLY treat if pregnant or urologic procedure
What are some of the complicated UTI patient characterisitics?
- Funtional/anatomical abnormal urinary tract
- Indwelling catheter
- Instrumentation
- Pregnant
- Men
- Elderly
- DM
What is the most common pathogen that causes UTIs?
- E. Coli
~30% are resistant to FQs, SMX-TMP
What are some of the risk facotrs for UTIs
Female? Males?
- Pregnancy [Female]
- Sex [Female]
- Diaphragm/Spermicide use [Female]
- No Circumcision [Male]
- Large Prostate [Male]
- Condom Catheter [Male]
What are some of the important things that we look at during a Urinalysis?
Components?
- Bacteria > 10^5
- WBC > 10
- Leukocyte Esterase indicates WBCs
- Nitrite Test: Are nitrates to Nitrites
Want a Midstream catch
Looking at Infection SYMPTOMS
What is the clinical presentation of Cystitis?
- NEW dysuria, urgency, frequency
- Suprapubic “heaviness” or lower back pain
Maybe foul smelling urine or Hematuria
What are some of the clinical presentation of Pyelonephritis?
- Fever +/- Chills, Rigor, Nausea, Vomiting, Diarrhea
- FLANK PAIN
What is the most common Genitourinary infection in Males?
- Prostatitis
What is the difference between Acute and Chronic Prostatitis?
- Acute: Fever, Chills, Malaise, cloudy urine, Swollen/Tender Prostate
- Chronic: Frequencym Urgency, Pelvic/Back Pain, Normal Prostate
What are some of the pathogens that causes Prostatits in Males?
- Gram (-): E. Coli, Proteus, P. Aeruginosa
- Gram (+): Enterococcus, S. Aureus
- Maybe: N. Gonorrhea, Chlamydia
What are the common antibiotics that are used to treat Genitourinary infectinos?
- Nitrofurantoin [Macrobid]
- SMX/TMP
- Fosfomycin
What is the mechanism of action for Nitrofurantoin?
- Disrupts cell wall formation by inhibiting acetyl-coenzyme-A
What is the Spectrum of Activity for Nirtofurantoin?
- Gram (-): E. Coli, Citrobacter, Salmonella, Shigella
- Gram (+): E. Faecalis, E. Faecium
Twice daily [MacroBID]: 100mg PO q12h
What are the imporant pharmacokinetics for Nirtofurantoin?
ADME?
- Absorption: Readily Absorbed
- Distribution: NOT to other areas
- Metabolism: Minimal Hepatic
- Elimination: Renal; Half Life ~20mins
Bacteriostatic or cidal
What are some of the adverse effects for Nirtofurantoin?
- GI: Nausea, Farting [little vomiting, diarrhea, stomach pain]
- Neuro: Headache [little dizziness, drowsiness, vertigo]
- Rare [Hemolytic Anemia (G6PD)…]
What are some important precautions for Nitrofurantoin?
- Contraindicated if CrCl < 30
- Old people might give false positives
- Its ok to use during pregnancy [ be cautious tho]
What is the mechanism of action for SMX-TMP?
- SMX: Inhibits Dihydrofolic Acid
- TMP: Inhibits Dihydrofloate Reductase
What is the Spectrum of activity for SMX/TMP?
- Gram (+): MRSA, Listeria
- Gram (-): E. Coli, K. Pneumonia, Enterbacter… [Stenotrophomnas is 1st line]
- Other: Jirovecii [Carinii]
Dosing: 5:1 - SMX:TMP ratio
DS Tab = 800/160mg
UTI: 1 DS BID
What are the important pharmacokinetics’ for SMX/TMP?
- Absorption: Excellent Orally
- Distribution: Widely Distributed
- Metabolism: Hepatic
- Elimination: Renal; Half Life ~ 11h
Bacteriostatic Alone; Bactericidal Together
What are some of the side effects for SMX/TMP?
- GI: Nausea, Abdonimal Pain, Vomiting, Diarrhea
- Rash
- Interstital Nephritis
- Hyperkalemia, Hyponatremia
What are some of the precautions for SMX/TMP?
- AVOID in pregnancy [Cat C]
- Drug interations –> WARFARIN
What is the mechanism of action for Fosfomycin?
- Inhibits cell wall synthesis
What is the spectrum of activity for Fosfomycin?
- E. Coli, Entercoccus sp.
- Resistant Organisms [ESBL, CRE, VRE]
