Recurrent UTIs Flashcards
describe prophylactic antibiotics
- can base on most recent culture
-especially if relapses - types:
-pulse: 1 week of every month get therapeutic course
-low dose: at night, so sits in bladder - risks:
-side effects
-drug resistance
describe ecotherapeutics
- prebiotics: giving nutrients for bugs to thrive on
- probiotics: giving live organisms
- symbiotics: mix of above
- post-biotics: parts of organisms
more is better!
-visbiome is great: most bugs per buck
how do you prevent bacteria from adhesion to the body?
- D-mannose
- cranberries: proanthocyanidins
- methenamine: cyclic hydrocarbon converted to low concentration formaldehyde in acidic environment only;
-usually given bound to an acidifying agent (DONT USE with alkalinizer)
-does not work with urease producing organism
-antiseptic, not antimicrobial, so no resistance
-complications: GI upset, cats often don’t tolerate, don’t use with acidosis associated diseases - nitrofurantoin
-good gram negative activity
-common complications: GI, hepatopathy, peripheral neuropathy
-should give every 6-8 hours but we just give q24hr
describe methenamine
- cyclic hydrocarbon converted to low concentration formaldehyde in acidic environment only
-antiseptic, not antimicrobial, so no resistance - -usually given bound to an acidifying agent (DONT USE with alkalinizer)
- does not work with urease producing organism
- complications:
-GI upset
-cats often don’t tolerate
-don’t use with acidosis associated diseases
describe nitrofurantoin
describe estrogens
- estriol!! premain, others
- dogs with recurrent vaginocystitis
-promotes vaginal epithelial turnovers
-turns over bacteria in distal lower urogenital tract - complications: estrous, feminization, bone marrow
describe glycosaminoglycans
- lines hollow organs and protects epithelium
- prevents:
-bacterial adherence
-bacterial toxins
NO clinical data though!
describe acidifers
- bacteria can survive in pH of 4-10 (5-9)
- dogs and cats CANNOT acidify urine below 5.5
-cannot acidify low enough to prevent bacterial infections
describe clarythromycin
- works against biofilm
-still unsure how to determine if dog or cat with infection has a biofilm
-use if suspect biofilm - better than other -mycins
- use with anti-emetic
-ex, maropitant
describe subclinical bacteruria
subclinical/occult (animals)
-bacteruria or positive c/s
-absence of signs
versus
asymptomatic (humans)
-positive culture
-absence of clinical signs or any evidence of infection
in humans, usually don’t treat! may increase risk of symptomatic UTI
-exceptions: transurethral resection of prostate, urologic procedure with bleeding, pregnancy, clinical signs difficult in some groups (paralysis, immunocompromised)
in what groups is there increased risk of subclinical bacteruria?
- obesity
- DM
3 post surgery
do ALL E. coli cause issues?
nah
describe diagnosis of subclinical bacteruria
- odor and color: not predictive
- microscopic sediment exam
-bacteria alone: 50% NOT UTI - determining urovirulence factors: no evidence
- consider imaging: could be a mass
- adjunct therapy (prophylactics)
- if develop clinical signs: treat
describe treat or not treat of subclinical bacteruria
don’t treat/antimicrobial NOT indicated:
1 RBC/WBC without signs: unsure in dogs and cats; use judgement?
- multi drug resistant bacteria: bacteria also likely in GI tract
if you treat:
- increase risk of ascending/systemic infection
- compromised patients: consider quality of life if having to treat for 5-7d
- non-correctable LUT disease (cancer): treat
- increased post void residual volume: maybe
- plaque producing bacteria: consider 5-7d of treatment
