Tx for LUT infections and STI's Flashcards
Penicillin G
Beta lactamase inhibitor
staph and some gram positive
- ADR: allergic reaction, anaphylaxis
Ampicillin
- Beta lactamase inhibitor
- some gram negative some gram positive
AE: allergies, anaphylaxis
Ceftriaxone
- Third generation cephalosporin, inhibits cell wall synthesis
NO ALCOHOL
Ampicillin-Sublactam
-Beta-lactamase inhibitor
MOA: inhbits transpeptidation reaction
Ciproloxacin/Levofloxacin
-Fluoroquinolones
MOA: targets bacterial DNA gyrase and topoisomerase IV (unable to undo supercoil of DNA)
ADR: GI, CNS, rash, achilles tendon rupture
Azithromycin
- MOA: bacteriostatic, binds reversibly to 50S ribosomal subunit
ADR: NAUSEA!!! (most common), GI, hepatotoxicity, QT prolongation
Metronidazole
Flagyl
ADR: h/a, nausea, dry mouth, neurotoxic
Sulfamethaxoazole/ trimethoprim
Bactrim
MOA: bacteriostatic : inhibits folic acid synthesis in bacteria (thus inhibiting DNA synthesis)
ADR: allergic skin rash, nausea, vomiting, photosensitivity
DDIs: inhibits CYP metaoblism –> potentiated effect of warfarin!
Methenamine
- MOA: acidification of urine
ADR: GI distress, painful/ frequent micturition
Nitrofurantoin
- MOA: reactive intermediates which damage DNA
ADRs: nausea, vomiting, diarrhea
CI: pregnant women, impaired renal fn.
Fosfomycin
- MOA: bactericidal - inhibits early stage of cell wall synthesis - decredased formation of N-acetylmuramic acid
ADR: diarrhea, nausea, ab pain
Fluconazole
= antifungal
- `AE: drug interactions and warfarin potentiation
uncomplicated infection tx?
infection in individuals who lack structural or functional abnormalities of the urinary tract. Occurs in pre-menopausal females of childbearing age (15-45 years) who are otherwise healthy.
usually E. coli and staph saprophyticus
tx:
1. Trimethoprim /sulfamethoxazole
2. Nitrofurantoin
3. Fosfomycin
male infection
not considered uncomplicated because these infections are rare and most often a result of a structural or neurological abnormality.
complicated infection
likely the result of a predisposing lesion (congenital abnormality or distortion), a stone, indwelling catheter, prostatic hypertrophy, obstruction, or neurologic deficit that interferes with the normal flow of urine and urinary tract defenses.
i) Occurs in both genders. Frequently involves upper and lower urinary tracts.
more varied microorganisms and often more resistant
recurrent UTI
in healthy, non-pregnant women; two or more UTIs within 6 months or three or more within one year.
i) Reinfection – different microorganism than what was originally isolated (accounts for the majority of recurrent UTIs).
ii) Relapse – same initial organism; usually indicates a persistent infectious source.
lower UTI presentation
dysuria, urgency, frequency, nocturia, suprapubic heaviness.
upper UTI presentation
flank pain, fever, nausea, vomiting, malaise.
elderly UTI presentation
do not usually experience specific urinary symptoms but will present with altered mental status, change in eating habits, or gastrointestinal symptoms.
3 DOC for uncomplicated cystitis
1**Trimethoprim/sulfamethoxazole (TMP/SMX) x3 days
(a) In areas with > 20% resistance of E. coli to TMP/SMX → use nitrofurantoin or fosfomycin.
2**Nitrofurantoin x5 days
3** Fosfomycin single-dose
NOTE: Fluoroquinolones (ciprofloxacin or levofloxacin) reserved for suspected or possible pyelonephritis due to risk of collateral damage (i.e. development of resistance).– there is increased resistance of E. Coli here (only used in second choice)
DOC for acute pyelonephritis
(a) Ciprofloxacin or levofloxacin preferred 1st line for 7-10 days
(b) TMP/SMX x14 days
(c) If amoxicillin/clavulanate or oral cephalosporin used, give ceftriaxone first then continue with oral agent to complete 10-14 day course.
(d) If gram-positive cocci identified on Gram stain, consider E. faecalis, direct treatment towards this potential pathogen (ampicillin).
tx for gonorrhea
ceftriaxone
Co-existing chlamydial infection documented in up to 50% of women and 20% of men with gonorrhea. Thus, all patients treated for gonorrhea should be treated with concomitant azithromycin or doxycycline for chlamydia
tx for chlamydia
Azithromycin as single, one-time dose.
Doxycycline twice daily for 7 days.
Fluoroquinolones do not offer an advantage over other 1st line agents.
In pregnancy: azithromycin and amoxicillin drugs of choice.
More frequently asymptomatic compared to gonorrhea.
If post-treatment cultures positive, usually represents noncompliance, failure to treat sexual partners, or lab error rather than inadequate therapy or resistance.
Abstain from intercourse x7 days following initiation of treatment.
tx for thricomoniasis
Metronidazole or tinidazole
Metronidazole contraindicated in first trimester. Metronidazole excreted in breast milk; interrupt breast feeding for 12-24 hours after maternal ingestion.
Males have high spontaneous cure rate even in the absence of treatment. High, one-time doses may cause GI complaints (anorexia, nausea, vomiting, diarrhea) and some patients may be unable to tolerate → use multi-dose regimen x5-7 days.
tx for syphilis
Penicillin G (has long duration of effect!)
highly contagious if not treated
Jarisch-Herxheimer reaction: benign, self-limiting reaction, characterized by flu-like illness (transient headache, fever, chills, malaise, myalgia, tachypnea), peripheral vasodilation, and aggravation of syphilitic lesions. Occurs independent of drug or dose used. Begins within 2-4 hours of initiating therapy, peaks at 8 hours, and is complete in 12-24 hours.
tx for sexually aqd epididymitis
ceftriaxone + doxyccline
tx for gram - epididymitis
ceftriaxone + levofloxacin
PID tx
Cefotetan or cefoxitin PLUS doxycycline; clindamycin PLUS aminoglycoside; single IM dose of ceftriaxone PLUS doxycycline +/- metronidazole.
bacterial vaginosis tx
Oral metronidazole or vaginal metronidazole or clindamycin.
candidiasis tx
: intravaginal butoconazole, clotrimazole, miconazole, terconazole, or tioconazole. OR single dose of oral fluconazole*.
chancroid tx
Single oral dose of azithromycin or IM dose of ceftriaxone.
Treat sex partners if there was sexual contact with infected individual within 10 days of symptom onset.
most common organism in uncomplicated UTI?
E. Coli and Staph saprophyticus
** all treated with TMP-SMX
what is amoxicillin most approriate for?
enterococcus faecalis
which uncomplicated UTI organisms do TMP-SMX cover?
E. Coli
Staph Saprophyticus
Klebsiella pneumonia
proteus mirbalis
which Ab is most likely prescirbed that can caused increased INR (interaction w/ warfarin)?
Trimethoprim /sulfamethoxazole (bactrim)
risk factors of MDR?
- Hospitalization in last 6 months
- Urinary catheter
- Nursing home resident
worry about pseudomonas and enterococci
empiric tx for pyelonephritis?
1 = Fluoroquinolone (Ciprofloxacin or Levofloxacin)
- TMP-SMX
- Ceftriaxone IV followed by Beta lactam
if has syphilis and allergic to penicillin?
tx with doxycycline
if pregnant and has penicillin allergy and need tx of syphilis?
need to desensitize (can’t use doxycycline with pregnant women) to penicillin
