Treatment of GU infections Flashcards
What organism should be targeted in cystitis?
E. coli, with hopes of covering other gram negatives, and S. saprophyticus
What are the first line treatments which need 3, 5, and 7 days of therapy?
3 days: TMP / SMX, and FQ (Levofloxacin and Ciprofloxacin only)
5 days: Nitrofurantoin
7 days: Beta-lactams - i.e. Cephalexin
How long is an antibiotics course for S. saprophyticus?
7 days
What is the mechanism of action of Fosfomycin?
Inhibits (fosfo)enolpyruvate transferase which inhibits cell wall synthesis
What is the practical clinical use of fosfomycin?
Given for cystitis / lower UTI infections with drug-resistant isolates, which is safe to use in pregnancy
What are the first line treatments for community-acquired pyelonephritis, given orally? Duration of therapy?
FQ (i.e. Cipro)
TMP/SMX
3rd generation Cephalosporin
Generally 7-14 days of therapy is fine, leaning towards 7
What two drugs used to treat lower UTIs cannot be used in pyelonephritis and why?
Nitrofurantoin / fosfomycin -> do not reach sufficient levels in the kidney tubules
What are the first line drugs for pyelonephritis UTI’s when hospitalization occurs?
IV drugs:
Fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, carbapenems (not empirically)
transition to oral therapy to complete course
What is the most common way to get a healthcare associated UTI and what organism must you cover?
From a Foley Catheter
Must cover P. aeruginosa
What are the drugs of choice for healthcare associated UTI?
Cefepime or ceftazidime Zosyn Cipro / Levo Carbapenems minus ertapenem Aminoglycosides
What two conditions absolutely need the treatment of asymptomatic bacteriuria?
- Pregnancy
- Urinary tract surgery / instrumentation
Neonates / renal transplant are less clear
How do you treat candiduria?
You don’t. Just discontinue Foley catheter and discontinue unnecessary antibiotics
What organism causes chancroid and how is it treated?
Azithromycin 1 g PO, 1 dose
Counts a 7 day course. Same treatment as Chlamydia.
Who else should be treated in the case of chancroid?
Anyone making sexual contact within 10 days of the partner’s symptoms
What is the treatment for first episode of HSV-2 genital herpes?
Valacyclovir twice daily x7-10 days.