Pharm Bacterial Vaginitis and UTI Flashcards
Bacterial Vaginosis (BV) Disruption of: Most common: S/SX: it may increase the risk of: Pregnant women may:
Disruption of the normal floral of the vagina
• Most common vaginal infection in women of childbearing age
•S/Sx = discharge, odor (Fishy smell), pain, itching, or burning.
• It may increase the risk of STDs
•Pregnant women may deliver premature or low birth-weight babies.
what organism causes BV
Gardnerella vaginalis – (Primary organism)
it is a facultative anaerobic gram-variable rod
Treatment of BV Drug: - - - Drug: - - - Preg-
Clindamycin = DOC
Oral: 300 mg PO q12hr for7 days
Suppositories: Insert 1 suppository into vagina qHS for 3 days
Vaginal Cream: 1 full applicator inserted intravaginally qHS for 3 days in nonpregnant patients and 7 days in pregnancy patients
Metronidazole (Available in oral or vaginal gel):
Nonpregnant Women Doses
• 500 mg PO BID x7 days OR
• 2 g PO qDay single dose OR
• Extended-release: 750 mg PO qDay x7 days
Pregnany Women
•500mg BID or 250 mg TID x 7 days
what are the side effects of Clindamycin?
Clindamycin is bacteriostatic
Risk of C. Diff is high (lower risk with the suppositories & cream)
what are the side effects of Metrondiazole? - - Benefits: - -
Educate patients to stay away from alcohol for at least 3 days after use (May cause disulfiram –like reactions)
Remember that antibiotics cause an increased risk of vaginal candidiasis….so watch for this post tx!
BENEFITS:
•Safe in pregnant women
•Bacteriocidal
Urinary Tract infection (UTI) and Pyelonephritis
s/s
Lower
Upper
If flank pain and fever
Elderly
Urinary urgency and frequency, Dysuria, Flank pain, Bloody urine, Fevers and Chills (mostly Pyelonephritis)
Lower UTI S/Sx = dysuria, frequency, nocturia, suprapubic heaviness, gross hematuria
Upper UTI S/Sx = flank pain, fever, nausea, vomiting, malaise
If + Flank pain, fever → pyelo/complicated = may need IV Abx (IM if outpatient) ceftriaxone
Elderly = usually have ortho/mental s/sx
Labs Bacteriura:
non mixed
Mixed
Symptomatic:
-
Non-Mixed Flora → Needs to be greater than 1,000 cfu/mL in culture
Mixed flura →Needs to be greater than 100,000 cfu/mL to be significant
When symptomatic →typically treat even without cfu criteria met
When asymptomatic →
•Treat if they are immuno-compromised (diabetics, etc) or have other risk factors even if cfu criteria is not met
•Do not treat if they healthy & cfu’s are > 100,000 cfu’s (probably don’t need to treat)
Organism of Urinary Tract infection (UTI) and Pyelonephritis
E.Coli (75-95%) most common….Others = Klebsiella pneumonia, Proteus mirabilis,
Organisms common in elderly?
Staphylococcus saprophyticus
Nosocomial UTI
MRSA, Pseudo, Klebsiella
is klebsiella is the organism what is the tx?
Carbapenem or quinalone
UNCOMPLICATED BLADDER INFECTION WITH NO RISK FACTORS (females only) treatment
Nitrofurantoin 100 mg BID x 5-7 days
•Do not use for kidney infection or if complicated, only use for bladder infection
Bactrim DS 160/800 mg BID x 3 days
•Can be used for uncomplicated bladder infection
Fosfomycin (Monurol) 3 g once- only if the other 2 fail
ACUTE PYELONEPHRITIS….aka COMPLICATED UTI this includes who: - - - - if fever is present then give what?
This includes any male with a UTI, any pregnant female with a UTI
o Bactrim DS BID for 14 days
o Ciprofloxacin 500 mg BID x 7 days
o Cipro ER 1000 mg QD x 7 days
o Levofloxacin 750 mg QD x 5 days
oIf fever is present (38degrees)then give 1g ceftriaxone IM then start oral doses after that
Side effects of Levo
Tendonitis, nerve damage and confection
Risk factors for complicated UTIs
Indwelling Catheters, Obstruction , Male gender, Diabetes mellitus, Renal insufficiency, Immunosupression (DM patients), Urolithiasis, Surgery, Voiding dysfunction, Reflux, Pregnancy, Nosocomial
If any of these risk factors are present….then treat the UTI as complicated!
