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Urinary Tract Infections Flashcards

1
Q

Lower UTI

A

Cystitis

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2
Q

Upper UTI

A

Pyelonephritis

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3
Q

Uncomplicated

A

Non-pregnant females with no structural abnormalities

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4
Q

Complicated

A

Males
Pregnant patients
Obstructions or Kidney Stones
Congenital abnormalities
Indwelling Catheters
Prostatic hypertrophy
Neurologic deficit

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5
Q

Etiology

A

Gram Positive: staphylococcus saprophyticus; Enterococcus faecalis
Gram Negative: E coli (80-90% of patients!); Pseudomonas aeruginosa; Proteus mirabilis; Klebsiella spp

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6
Q

Bacteriuria

A

Bacteria in the urine

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7
Q

Pyuria

A

Increased WBC in the urine

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8
Q

Urinary Tract Infection

A

Presence of microorganisms in the urinary tract not due to contamination producing symptoms and with the potential to invade the tissues

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9
Q

Clinical Presentation - Cystitis

A

Dysuria
Frequency
Urgency
Suprapubic pain
Hematuria
Nocturia

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10
Q

Clinical Presentation - Pyelonephritis

A

Fever
Chills
Nausea/Vomiting
Suprapubic pain
Hematuria
Flank Pain
Costovertebral angle tenderness (CVA)

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11
Q

Goals of Therapy

A

Symptom Resolution
Prevent or treat systemic consequences
Eradicate invading organisms
Prevent recurrence
Minimize consequences associated with therapy
Limit collateral damage

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12
Q

First Line Uncomplicated Cystitis

A

Nitrofurantion
Trimethoprim/Sulfamethoxazole
Fosfomycin

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13
Q

Nitrofurantoin Dosing (uncomplicated)

A

100 mg PO BID for 5 days

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14
Q

Nitrofurantoin Adverse Reactions

A

urine discoloration
pulmonary toxicity

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15
Q

Trimethoprim/Sulfamethoxazole dosing (uncomplicated)

A

160/800 mg PO BID for 3 days

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16
Q

Trimethoprim/Sulfamethoxazole Adverse Reactions

A

photosensitivity
crystalluria
Rashes (SJS)

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17
Q

Nitrofurantoin Considerations

A

Discouraged use CrCl 60 mL/min but can be safe down to CrCl 30 mL/min

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18
Q

Trimethoprim/Sulfamethoxazole Considerations

A

There is an increase of resistance

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19
Q

Fosfomycin Dosing

A

3g PO for one dose

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20
Q

Fosfomycin Considerations

A

1 dose!

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21
Q

Uncomplicated second line therapy

A

Fluroquinolones- ORAL (ciprofloxacin, levofloxacin)
Beta-Lactams ORAL (amox/clav; cefaclor; cefpodoxime)

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22
Q

Fluroquinolones Uncomplicated Durations

A

3 days

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23
Q

Fluroquinolones Uncomplicated Considerations

A

Increased resistance

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24
Q

Beta-Lactams Uncomplicated Durations

A

3-7 days

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25
Q

Beta-Lactams Considerations

A

Decreased efficacy for shorter durations - 5-7 days are more effective than 3 day treatments

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26
Q

Uncomplicated Durations

A

Nitrofurantoin: 5 days
Trimethoprim/Sulfamethoxazole: 3 days
Fosfomycin: 1 day
Fluoroquinolones: 3 days
Beta-Lactams: 5-7 days

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27
Q

Male Urinary Tract Treatments

A

Nitrofurantoin
Sulfamethoxazole/Trimethoprim
Fosfomycin

28
Q

Male urinary tract nitrofurantoin dosing

A

100 mg po BID for 7 days

29
Q

Male urinary tract nitrofurantoin duration

30
Q

Male urinary tract trimethoprim/sulfamethoxazole dosing

A

160/800 mg PO BID for 7 days

31
Q

Male urinary tract trimethoprim/sulfamethoxazole duration

32
Q

Male urinary tract Fosfomycin dosing

A

3 g PO every other day for 3 doses

33
Q

Male urinary tract Fosfomycin duration

A

every other day for 3 days

34
Q

Non-obstructing renal stone Treatments

A

Fluoroquinolones
Trimethoprim/Sulfamethoxazole
Beta-lactams
Other susceptible agents

35
Q

Non-obstructing renal stone Fluoroquinolone duration

36
Q

Non-obstructing renal stone trimethoprim/sulfamethoxazole duration

37
Q

Non-obstructing renal stone beta-lactams duration

38
Q

Non-obstructing renal stone other agents duration

A

usually 14 days

39
Q

Urinary retention or Neurogenic bladder treatment

A

Any susceptible agent

40
Q

Mechanical impairment to urinary flow treatment

A

Any susceptible agent

41
Q

Urinary retention or Neurogenic bladder treatment duration

42
Q

Mechanical impairment to urinary flow treatment duration

43
Q

Catheter-associated UTI treatment options

A

Remove or change cathether
Bacteriuria treatment

44
Q

Catheter-associated UTI treatment duration with ABX

A

7 days; may be up to 10-14 days

45
Q

UTI during pregnancy

A

Treat bacteriuria WITH or WITHOUT symptoms

46
Q

Pregnancy treatment options

A

Amoxicillin
Amox/Clav
Cephalexin
Nitrofurantoin (NOT close to delivery)

47
Q

Drugs to AVOID in pregnancy

A

Tetracyclines
Trimethoprim/Sulfamethoxazole
Fluoroquinolones

48
Q

Pregnancy Treatment duration

49
Q

Treatment options in children

A

Amox/Clav (PO)
Trimethoprim/sulfamethoxazole (PO)
Second or third generation cephalosporin (PO or IV)
Ampicillin/Sulbactam (IV)
Aminoglycosides (IV)

50
Q

Treatment duration in children

51
Q

Pyelonephritis inpatient treatments

A

Ceftriaxone
Gentamicin
Levofloxacin
Ciprofloxacin
Ertapenem

52
Q

Pyelonephritis dosing: ceftriaxone

A

1 g IV daily

53
Q

Pyelonephritis dosing: gentamicin

A

5-7 mg/kg IV daily

54
Q

Pyelonephritis dosing: levofloxacin

A

750 mg IV daily

55
Q

Pyelonephritis dosing: Ciprofloxacin

A

400 mg IV every 8-12 hours

56
Q

Pyelonephritis dosing: Ertapanem

A

1 g IV daily

57
Q

Pyelonephritis Outpatient Treatment

A

Fluoroquinolones (PO)
Ceftriaxone IV then Fluoroquinolone PO
Ceftriaxone IV then Trimethoprim/Sulfamethoxazole PO
Aminoglycoside IV then Fluoroquinolone PO
Aminoglycoside IV then Trimethoprim/Sulfamethoxazole PO

58
Q

Prostatitis

A

Inflammation of prostate gland and surrounding tissue

59
Q

Clinical presentation of prostatitis

A

High fever
Chills and malaise
Localized pain
Increased urinary frequency, urgency, and retention

60
Q

Prostatitis acute treatment

A

Trimethoprim/sulfamethoxazole
Cephalosporin
Fluoroquinolones
Beta-lactam/inhibitor combinationP

61
Q

Prostatitis acute treatment duration

62
Q

Prostatitis chronic treatment

A

Trimethoprim/sulfamethoxazole
Fluoroquinolones

63
Q

Prostatitis chronic treatment duration

A

4-6 weeks; may be up to 12 weeks

64
Q

ONLY treat asymptomatic bacteriuria in….

A

Pregnant patients
Children

65
Q

Recurrent management

A

Less than 3 episodes a year: treat each episode separately
More than 3 episodes a year: treat each episode and consider prophylaxis treatment

Therapeutics (10 decks)

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