Renal- Renal Infxs and Antibiotics Flashcards
What is the typical presentation of cystitis
-Young, nonpregnant female
What is the pathogenesis of UPEC
- Biofilm like intracellular Bacterial communities
- Type 1 pili, antigen 43, Curli
In the case of a complicated severe pyelonephritis, what drug can be used
Beta lactam + beta lacamase inhibitor or a carbapenem
What is the treatment for acute proliferative glomerulitis
- Aka post streptococcal glomerulonephritis
- Loop diuretic, antihypertiesive, dialysis
- Antibiotics
In the case of a complicated mild pyelonephritis, what drug can be used
Ceftriaxone, Ciprofloxacin, levofloxacin, or aztreonam
How is imipenem metabolized
By dihydropeptidase in the kidney
Which common causing complicated UTI are good inhibitors of the class A beta lactamases
E. Coli and Klebsiella
What are the adverse effects in the use of Fluoroquinolones
Tendinitis and tendon rupture
Peripheral neuropathy
CNS effects
During complicated UTI, was is usually the pathogenesis occurring
Inflammatory response in the bladder due to neutrophils, along with fibrinogen accumulation in the case of catheters
What is the most common clinical presentation of complicated UTI and what is the most common cause
Severe dysuria, with 70-80% being due to indwelling catheters
Complicated UTI is normally occurring in which conditions
-Compromised urinary tract or host defenses (such as catheters, urinary obstructions, renal failure, etc.)
What drug is given in the cause of cystitis with resistance
Ertapenem (except ineffective against P. Aeruginosa
What are the clinical symptoms of pyelonephritis
-Unilateral back or flank pain with a fever
Which bacteria are very vulnerable to clindamycin
- Anaerobes
- strep, staphyl and pneumococci
What are the contraindications for nitrofurantoin
- Antagonizes nalidixic acid (synthetic quinolone antibiotic)
- Not to be used in patients G6PDH deficiency
Which bacteria should not be treated with nitrofurantoin
P aeruginosa and Proteus are resistant
What are the fluoroquinolones used to treat pyelonephritis
Ciprofloxacin or levofloxacin
What is the pathogenesis of P. Aeruginosa
- Microcolony formation by changing hydrophobicity of the surface
- Lectins, rhamnolipids
What is an adverse effect of using clindamycin for treatment
C. Difficile induced diarrhea and colitis
Which of the first line beta lactams is not given with a beta lactamase inhibitor
Cefepime
What are the drugs used in the treatment of complicated pyelonephritis that are classified as beta lactamase inhibitors
- Tazobactam
- Avibactam
What is the pathogenesis of P. Mirabilis
- Produces urease
- Calcium crystals and magnesium phosphate precipitates
- Crystaline biofilms
Which drug 3rd line drug should not be used to treat cystitis
-Moxifloxacin
What is the treatment of a prostatitis
TMP-SMZ, Ciprofloxacin, levofloxacin
What are Fluoroquinolones commonly used in cystitis
- Ciprofloxacin
- Levofloxacin
- Oflaxacin
What is the pathogenesis of E. Faecalis
Fibrinogen
Which drugs should not be used to empirically treat uncomplicated cystitis
Ampicillin and amoxicillin
What can be used to treat a complicated pyelonephritis in a pt with beta lactam allergy
Aztreonam
What are the adverse effects with nitrofurantoin
-Anorexia, nausea, vomiting
Which drug should be given to treat a complicated cystitis caused by gram positive cocci on gram stain
*Suggests enterococcus UTI (E.faecalis, faecium)
Ampicillin or amoxicillin
Phenazopyridine
What is the second line for treatment of cystitis
-Oral beta lactams
Which bacteria are targeted by fosfomycin
Gram positive and negative bacteria
What are the pharmokenetics of nitrofurantoin
Metabolized and excreted by kidneys very quickly, so there is no systemic antibacterial effect
What are the agents used for first line of treatment for cystitis
Nitrofurantoin
Fosfomycin
Trimethoprim-sufamethoxazole (TMP-SMX)
Which drug will cause urine to change orange or red
Phenazopyridine
Which bacteria are not affected by aztreonam
Gram positive or anaerobes
Can fosfomycin be used in pregnancy
Yes
Majority of cases of a prostatitis is caused by which pathogen
E. Coli
What are the adverse effects of fosfomycin
Limited headaches
What are the pharmokenetics of fosfomycin
Oral form with 40% bioavailability
What is the mechanism of action for fosfomycin
-Cell wall synthesis inhibitor by blocking enolpyruvate transferase Via binding to the cysteine residue of the active site
What are the symptoms of cystitis
- Dysuria, urinary frequency and urgency
- Nocturia, hesitancy, suprapubic discomfort, gross hematuria
Which bacteria are affected by aminoglycosides
Aerobic gram negative with P.aeruginosa
When is the second line of treatment for pyelonephritis used
When pt has Fluoroquinolone hypersensitivity or resistance
What are the oral beta lactams used in the treatment
- Amoxicillin (aminopenicillin)
- Cefpodoxime (3rd gen)
- Cefdinir (3rd gen)
- Cefadroxil (1st gen)
When is aztreonam used in the treatment of pyelonephritis
When patients can not handle the other treatment drugs
What is a common characteristic of bacteria causing a complicated UTI
More likely to be resistant to commonly used oral agents used in the treatment of uncomplicated UTI
When are fluoroquinolones used in the treatment of pyelonephritis
Severe cases or where there is resistance
What are the adverse effects of aminoglycosides
- CN VII toxicity with vertigo and hearing loss
- Renal toxicity
- NM blockage
What are the aminoglycosides used in the treatment of pyelonephritis
Gentamicin or tobramycin
Which common causing complicated UTI are good inhibitors of the class C beta lactamases
- Enterobacter spp.
- P. aeruginosa
When should nitrofurantoin and fosfomycin not be given
If there is suspicion of early pyelonephritis because does not have the adequate renal tissue levels
What are the symptoms and clinical presentation of a case of asymptomatic bacteriuria (ASB)
No symptoms and will only present with bacteria in the urine
What is the mechanism of action for nitrofurantoin
Bacterial reductases converts nitrofurantoin into highly reactive intermediate that targets bacterial machinery and DNA/RNA
What are the second line of treatments for pyelonephritis
- TMP-SMX
- Oral beta lactams
- aztreonam
What is the most common cause of UTI
UPEC or uropathogenic E.Coli
How are dori-,mero-, and Erta- metabolized
Not by dihydropeptidase
What are the bacterial that can cause complicated UTI
- E. Coli
- K. Pneumonia
- Enterobacter spp.
- P. Aeruginosa
What are the first line treatment for pyelonephritis
-Fluoroquinolones and aminoglycosides
In the case of a complicated cystitis, what drug can be used
Ciprofloxacin or levofloxicin
What are the uncomplicated UTI
Acute cystitis or pyelonephritis (usually in a nonpregnant outpatient women without an atomic abnormalities)
What is the mechanism of action for aminoglycosides
Irreversible protein synthesis inhibator on 30S
Interference with the initiation complex
Misreading of mRNA
What is the third line for treatment of cystitis
Fluoroquinolones
Which bacteria are targeted with Nitrofurantoin
Gram positive and negative
