Recurrent UTI Flashcards
Choose all correct answers:
a) persistent presence of E coli on culture despite Abx tx is an indication for cystoscopy
b) presence of hematuria once is indication for cystoscopy
c) indications for daily prophylaxis are 2 or more confirmed UTIs in 6/12 or 3 or more in a year
d) women with recurrent UTIs post-intercourse should be offered daily Abx prophylaxis
e) acute self-tx with Abx is reasonable in compliant, motivated pt with hx documented UTIs
a) false -persistent presence of any bacteria other than E coli is indication for cysto
b) false -persistent hematuria is indication for cysto and imaging of upper urinary tract
c) true
d) false -should be offered post-coital prophylaxis to minimize cost/AEDs
e) true
Choose all correct answers:
a) options for post-menopausal women with recurrent UTIs include Abx prophylaxis as well as vaginal estrogen
b) there is evidence that cranberry products reduce the recurrence of UTIs
c) acupuncture should be discouraged in women with recurrent UTIs
d) there is good evidence to support the use of oral probiotics for the prevention of recurrent UTIs
e) daily prophylactic Abx are contraindicated in pregnancy
a) true
b) true
c) false -can be used as alternative prophylaxis in women who don’t tolerate Abx prophylaxis
d) false -some evidence for PV lactobacillus
e) false -can be used throughout pregnancy up to 36 weeks
Choose all correct answers:
a) recurrent UTI is defined as 2 or more acute infections in 6/12 or 3 or more in 12/12
b) acute cystitis is more common in post-menopausal women than young women
c) reinfection with new bacteria is more common than relapse (same bacteria on culture following tx)
d) in women with LUTs symptoms the probability of a probable culture is only 50%
a) true
b) false
c) true
d) false, 80%
Recurrent UTIs are typified by all the following symptoms except:
a) post-coital sx
b) prior pyelonephritis
c) presence of nocturia
d) prompt resolution of sx (<48hrs) after tx started
c
What are the most common organisms causing acute uncomplicated UTI?
E coli (80%) klebsiella (4%) proteus (4%) saprophyticus (4%) enterococcus less common in women
List 5 risk factors for recurrent UTI:
new sexual partner, spermicide use, hx prev recurrent UTI (particularly if <15 years old), DM, voiding dysfunction, prolapse, lack of estrogen post-menopause, maternal hx UTI,
Choose all correct answers:
a) presence of klebsiella on culture is indication for cystoscopy and imaging of upper tract
b) symptomatic women with culture showing > 1000 CFU/hpf (10^3) bacteria likely have UTI requiring tx
c) the lack of nitrites on R and M rules out UTI requiring tx
d) the presence of leukocyte esterase is sensitive test for UTI
a) true (or proteus, enterococcus, pseudomonas or other unusual species)
b) true
c) false -specific but not sensitive test
d) true -produced by neutrophils, indicates pyuria
Choose all correct answers:
a) ampicillin is good first-line choice for tx uncomplicated UTI
b) a 3 day Abx regimen is preferred to a 7-day course
c) contraindications to the use of septra include: diabetes, recent hospitalization, Abx use in prev 3 months, recent septra use
d) floroquinolones are reasonable 2nd line if contraindication to 1st line
e) macrobid (7 days) or fosfomycin (1 dose) can be used for patients with complicated UTI
a) false -up to 1/3 resistance
b) true -increased compliance (TMP-SMX first line)
c) true
d) true though concerns re: inc resistance with cipro
e) false -ok for uncomplicated
Which of the following is there evidence to avoid in women with recurrent UTI?
a) spermicide
b) hot tub
c) douching
d) delayed voiding habits
e) having an elevated BMI
a only (though behavioural approaches unlikely to be harmful according to guideline
What is the NNT with prophylactic daily Abx to prevent one UTI?
2.2
Which patients should be prescribed daily prophylaxis and which ones should be prescribed Abx for self-administration with symptoms?
daily low-dose or post-coital prophylaxis if 3 or more documented UTIs in one year
if 2 or fewer UTIs per year but motivated pt can give Rx for self-administration
Give one medication and dosing regimen for each of:
a) daily prophylaxis
b) post-coital prophylaxis
c) patient self-administered tx
Lots of options:
a) macrobid 100mg daily or septra 50mg daily or 3x per week
b) septra DS 40/200mg x1 or keflex 250mg x1
c) septra 160/800mg BID x 3 days or cipro 250mg BID x 3/7
Choose all correct answers:
a) adverse effects with prophylactic Abx may include nausea and vaginal/oral candidiasis
b) adverse effects with septra include aplastic anemia
c) adverse effects with nitrofurantoin can rarely include hepatocellular or pulmonary toxicity
d) prophylaxis has been studied in patients for up to 5 years
a) true
b) false -associated with nitrofurantoin
c) true
d) false -studied up to one year -can use longer -most pts revert to previous pattern of infection once stopped
Choose all correct answers:
a) pregnant pts with hx recurrent UTIs should be counselled about increased risk of PTB and LBW
b) prophylactic septra can be offered to pregnant patients for prevention of recurrent UTIs
c) test of cure is not required in pregnant pts treated for a single episode of asymptomatic bacteruria
d) patients with a single episode of asymptomatic bacteruria should have monthly cultures done until the end of pregnancy
a) true
b) false -septra C/I outside of T2-use macrobid 50mg or keflex 250mg daily
c) false
d) true
When in pregnancy would you NOT use the following Abx and why?
a) septra
b) macrobid
c) tetracyclines
d) ahminoglycosides
e) floroquinolones
a) contraindicated outside of T2 (folic acid antagonist/theoretical risk kernicterus if given in days before delivery)
b) T3 -can cause hemolytic anemia if mother/baby has G6PD (rare), soft assoc with birth defects in T1 as well
c) generally avoid -suppression of bone growth, staining of teeth (NO teratogenic effects of doxycycline shown)
d) ototoxicity with prolonged use -avoid in pregnancy
e) toxic to developing cartilage -avoid in general
