Treatment of GU infections Flashcards

1
Q

What organism should be targeted in cystitis?

A

E. coli, with hopes of covering other gram negatives, and S. saprophyticus

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2
Q

What are the first line treatments which need 3, 5, and 7 days of therapy?

A

3 days: TMP / SMX, and FQ (Levofloxacin and Ciprofloxacin only)

5 days: Nitrofurantoin

7 days: Beta-lactams - i.e. Cephalexin

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3
Q

How long is an antibiotics course for S. saprophyticus?

A

7 days

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4
Q

What is the mechanism of action of Fosfomycin?

A

Inhibits (fosfo)enolpyruvate transferase which inhibits cell wall synthesis

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5
Q

What is the practical clinical use of fosfomycin?

A

Given for cystitis / lower UTI infections with drug-resistant isolates, which is safe to use in pregnancy

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6
Q

What are the first line treatments for community-acquired pyelonephritis, given orally? Duration of therapy?

A

FQ (i.e. Cipro)
TMP/SMX
3rd generation Cephalosporin

Generally 7-14 days of therapy is fine, leaning towards 7

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7
Q

What two drugs used to treat lower UTIs cannot be used in pyelonephritis and why?

A

Nitrofurantoin / fosfomycin -> do not reach sufficient levels in the kidney tubules

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8
Q

What are the first line drugs for pyelonephritis UTI’s when hospitalization occurs?

A

IV drugs:
Fluoroquinolones, aminoglycosides, 3rd generation cephalosporins, carbapenems (not empirically)

transition to oral therapy to complete course

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9
Q

What is the most common way to get a healthcare associated UTI and what organism must you cover?

A

From a Foley Catheter

Must cover P. aeruginosa

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10
Q

What are the drugs of choice for healthcare associated UTI?

A
Cefepime or ceftazidime
Zosyn
Cipro / Levo
Carbapenems minus ertapenem
Aminoglycosides
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11
Q

What two conditions absolutely need the treatment of asymptomatic bacteriuria?

A
  1. Pregnancy
  2. Urinary tract surgery / instrumentation

Neonates / renal transplant are less clear

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12
Q

How do you treat candiduria?

A

You don’t. Just discontinue Foley catheter and discontinue unnecessary antibiotics

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13
Q

What organism causes chancroid and how is it treated?

A

Azithromycin 1 g PO, 1 dose

Counts a 7 day course. Same treatment as Chlamydia.

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14
Q

Who else should be treated in the case of chancroid?

A

Anyone making sexual contact within 10 days of the partner’s symptoms

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15
Q

What is the treatment for first episode of HSV-2 genital herpes?

A

Valacyclovir twice daily x7-10 days.

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16
Q

What is suppressive therapy for HSV-2?

A

Reduces frequency of HSV breakouts, best for patients with frequent (>6) per year.

Once daily Valacyclovir or 2x acyclovir

17
Q

What do you do if HSV-2 recurs?

A

5 day course of acyclovir / valacyclovir

18
Q

What is the treatment for severe disseminated HSV causing encephalitis or other major complications?

A

IV acyclovir x 2-7 days until improvement, oral therapy to complete a 10 day course

19
Q

What is the treatment for primary / secondary syphilis? What do you do if the patient has an allergy?

A

Benzathine penicillin G, 2.4 million units IM x1

If patient has allergy: desensitize. Doxycycline, ceftriaxone, and azithromycin are way less effective

20
Q

What are the treatments for latent and tertiary syphilis?

A

3 doses of Benzathine penicillin G, 2.4 million units IM, separated by 1 week

21
Q

What is the treatment for neurosyphilis (CNS involvement)?

A

24 million units of IV aqueous penicillin G x10-14 days

Literally 10x the dose

22
Q

What is the Jarisch-Herxheimer reaction? How is it treated?

A

Headache, myalgias, fever, and tachycardia occurring 1-2 hours after starting treatment of syphilis due to release of pyrogen from spirochetes, can last 1-2 days.

Treated via anti-inflammatories

23
Q

What is the treatment for Chlamydia trachomatis?

A

Azithromycin 1g PO x 1 dose

or (macrolide allergy)

Doxycycline 100 mg PO x 7 days

24
Q

What should be done for sexual partners exposed to Chlamydia-infected person?

A

If within 60 days of symptoms, come for ID consult (was 10 days for chancroid)

25
Q

What organism should be considered for non-gonoccal urethritis if doxycycline was given?

A

Mycoplasma genitalium

A second, less likely cause of non-gonococcal urethritis.

Treat with moxifloxacin (assuming they had doxy due to azithromycin allergy)

26
Q

What are two uncomplicated gonococcal infections and what is the treatment?

A

Cervicitis, urethritis

Treatment: Ceftriaxone 250 mg IM x 1

+

Azithromycin 1g PO x 1 dose (always treat for chlamydia)

27
Q

What can be given for gonococcal infection if the patient has a cephalosporin allergy?

A

Gentamicin

28
Q

What are the treatments for bacterial and fungal vaginosis?

A

Bacterial: Gardnerella - Metronidazole x 7 days
Fungal: Fluconazole x 1 dose

29
Q

What is the treatment for trichomonas vaginalis?

A

Metronidazole in a 2g x 1 dose

Or 500 mg bid x 7 days (same as Gardnerella)

30
Q

What are the organisms causing PID?

A
  1. N. gonorrhea
  2. C. trachomatis
  3. gram negatives and anaerobes
31
Q

What is the empiric regimen for PID?

A

Cefoxitin to cover gonorrhea
+
Doxycycline to cover chlamydia

BOTH GIVEN IV until there is a response

32
Q

What are the most likely causative organisms of epididymitis?

A

C. trachomatis / N. gonorrhea

If anal intercourse: GI flora i.e. E. coli or P. aeruginosa

33
Q

What is the treatment of epididymitis?

A

Ceftriaxone IM + doxycycline

Substitute levofloxacin for doxy if enteric organisms are a concern (cover pseudomonas)