Renal Infections Sheehy

Question 1

Pharm Tx cystitis

Answer 1

1) Nitrofurantoin, trimethoprim-sulfamethoxazole (TMP-SMX), fosfomycin
2. Oral beta lactams: amoxicillin, cefpodoxime, cefdinir, cefadroxil
3. Fluoroquinolones: ciprofloxacin, levofloxacin, ofloxacin

Question 2

Cystitis first line

Answer 2

nitrofurantoin

Question 3

Bactericidal for g+ and g- bacteria in cystitis

Answer 3

nitrofurantoin

Question 4

nitrofurantoin: MOA, pharmcokinetics, AE, CI

Answer 4

Not fully understood

• Conversion of nitrofurantoin into highly reactive intermediates by bacterial reductases
• Toxic intermediates react nonspecifically with many ribosomal proteins and disrupt synthesis of proteins, RNA, DNA, and metabolic processes

Pharmacokinetics : metabolized and excreted so quickly no systemic antibacterial action is achieved

Question 5

side effects include anorexia, nausea, vomiting

antagonizes nalidixic acid (quinolone Abs)

contraindicated in patietns with glucose 6 phosphate dehydrogenase deficiency

Answer 5

Nitrofurantoin

Question 6

strains resistant to nitrofurantoin

Answer 6

p aeruginosa and proteus

Question 7

cell wall synthesis inhibitor, only oral form approved in the US. Safe in pregnancy but has limited diarrhea and headaches

Answer 7

Fosfomycin: active against gram + and gram -

Question 8

first line agents in cystitis

Answer 8

nitrofurantoin and fosfomycin
trimethoprim-sulfamethoxazole
(TMP-SMX )

Question 9

should not be taken if there is suspicion of early pyelonephritis

Answer 9

nitrofurantoin and fosfomycin

Question 10

should be avoided if prevalence of resistance is known to exceed 20%

Answer 10

trimethoprim-sulfamethoxazole (TMP-SMX)

Question 11

Cystitis: 2nd line agents

Answer 11

ORAL beta-lactams

Amoxicillin – aminopenicillin

Cefpodoxime – 3rd generation cephalosporin

Cefdinir – 3rd generation cephalosporin

Cefadroxil – 1st generation cephalosporin

Less effective than fluoroquinolones and TMP-SMX

Fluoroquinolones have more adverse effects, hence third line

Question 12

Cystitis: 3rd line agents

Answer 12

Fluoroquinolones
• Ciprofloxacin
• Levofloxacin
• Ofloxacin

Question 13

Not recommended for cystitis: attains lower urinary levels than other drugs in this class

Answer 13

Moxifloxacin is NOT recommended

Attains lower urinary levels than other fluoroquinolones

Question 14

Tendinitis and tendon rupture
Peripheral neuropathy
CNS effects

Answer 14

disabling and potentially irreversible adverse effects of systemic fluoroquinolones outweigh their benefits in treating uncomplicated cystitis

Question 15

Cystitis tx resistance: drugs to be avoided in cases of uncomplicated cystitis

Answer 15

ampicillin and amoxicillin- may contribute to resistance of uropathogen e. coli though it is rare.

Question 16

resistance to oral Abs: drug to use

Answer 16

carbapenem: Ertapenam
wide specturm
good activity against g- and g+ and anaerobes

Question 17

Unilateral back or flank pain, fever

Answer 17

cystitis

• Severe → High fever, rigors, nausea, vomiFng, and flank and/or loin pain
• Development of bacteremia (20-30%)
• Clinical presentation
• Fever (not present in cystitis), lower back pain • May or may not have symptoms of cystitis
• Treatment
1. Fluoroquinolones (ciprofloxacin, levofloxacin)
2. Trimethoprim-sulfamethoxazole (TMP-SMX), oral beta lactam, aztreonam

Question 18

Low grade fever, costovertebral- angle pain

Answer 18

Unilateral back or flank pain, fever

Mild → Low grade fever with or without lower back pain or costovertebral- angle pain

Severe → High fever, rigors, nausea, vomiFng, and flank and/or loin pain

Development of bacteremia (20-30%)
• Clinical presentation
• Fever (not present in cystitis), lower back pain
• May or may not have symptoms of cystitis
• Treatment
1. Fluoroquinolones (ciprofloxacin, levofloxacin)
2. Trimethoprim-sulfamethoxazole (TMP-SMX), oral beta lactam, aztreon