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Therapeutics > Urinary Tract infections > Flashcards

Urinary Tract infections Flashcards

1
Q

what criteria determines if you have asymptomatic bacteriuria?

A
  1. colony count > 10^5 cfu/ml but not UTI symptoms with or without pyuria
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2
Q

When should you treat asymptomatic bacteriuria?

A
  1. If patient is pregnant
  2. persistent bacteriuria 48 hours after removing urinary catheter.
  3. Urologic procedures where bleeding is anticipated.
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3
Q

what is urethritis?

A

inflammation of urethra usually as a result of STI’s

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4
Q

what is cystitis?

A

inflammation of bladder and urethra

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5
Q

what is prostatitis?

A

inflammation of the prostate

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6
Q

what is pyelonephriis?

A

inflammation of the kidney

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7
Q

what is urospesis?

A

Must have altered mental status+ drop blood pressure+ UTI symptoms and 2 or > of the following

  1. Temp > 38 C < 36 C
  2. > 90 beats per minute
  3. RR > 20 breaths/min
  4. paCO2 < 32mmHg
  5. WBC > 12, 000/ mm3 or < 4,000/mm3
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8
Q

What are the risk factors for UTIs?

A

woman

  • pregnant
  • vagina atrophy

immunocompromised

  • children, elderly
  • diabetes

Obstruction

  • catheterization &hospitalization
  • unable to void
  • kidney stones
  • tumors
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9
Q

which organisms are most likely to be involved in UTI? (community acquired)

A 
Gram -
E.coli ** most common
proteus mirabilis
kleibsiella
enterobacter
pseudomonas

Gram +
S. Saprophyticus
Broup b streptococcus
enterococcus

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10
Q

which organisms are most likely to be involved in UTI? (hospital acquired)

A

PEK
CAPES
enterococcus
staphylococcus

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11
Q

what is dysuria

A

painful burning urination

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12
Q

what is hematuria?

A

blood in urine

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13
Q

what is bacteriuria?

A

bacteria in urine

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14
Q

what’s pyuria?

A

WBC is urine

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15
Q

what is nocturia?

A

waking up to urinate at night

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16
Q

what are the lower urinary tract infection subjective symptoms?

A 
dysuria
urgency
frequency
nocturia
suprapubic pain
back pain
hematuria
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17
Q

what are the lower UTI objective symptoms?

A 
cloudy urine
pyuria
hematuria
elevated pH
leukocyte esterase
\+- nitrates
bacteriuria
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18
Q

If you are nitrite positive in ur urine, what does that say about the organisms?

A

they are enteric gram negative rods

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19
Q

If you have alkaline urine, what does that say about the organisms?

A

they are enteric gram negative rods

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20
Q

If you are leukocyte esterase positive in ur urine, what does that mean?

A

indicates pyuria (WBC in urine)

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21
Q

what are the upper UTI subjective signs and symptoms?

A 
all the lower UTI signs and symptoms and 
flank pain
fever 
chills
nausea/vomiting
weight loss
\+CVA tenderness
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22
Q

when should you obtain/order a culture for a UTI?

A
  1. if it is an upper UTI
  2. if it is a complicated UTI
  3. Failed treatment for lower UTI
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23
Q

when is a UTI considered a complicated UTI?

A
  1. involves upper urinary tract +- systemic complications
  2. catheterization, instrumentation, kidney stones, tumors
  3. children, elderly, immunocompromised patients
  4. pregnancy
  5. men
  6. hospital-acquired
  7. high frequency of recurrence.
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24
Q

when is a UTI considered an uncomplicated UTI?

A
  1. lower urinary tract: cystitis, urethritis

2. pre-menopausal, non pregnant woman age 15-45

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25
Q

what agents can you use to treat acute uncomplicated cystitis?

A
  1. sulfamethoxazole/trimethoprim*
  2. nitrofurantoin*
  3. fosfomycin*
  4. fluoroquinolones: cipro/levofloxacin
  5. beta lactams: amoxi/clavula or cefpodoxime
26
Q

what doses of SMP/TMP for acute uncomplicated cystitis?

A

1 DS (800/600) tab po bid x 3 days

27
Q

what doses of nitrofurantoin for acute uncomplicated cystitis?

A

macrobid 100mg po bid x 5-7 days

28
Q

what doses of fosfomycin for acute uncomplicated cystitis?

A

3g po single dose

29
Q

what doses of ciprofloxacin for acute uncomplicated cystitis?

A

250mg po BID x 3 days

30
Q

what doses of levofloxacin for acute uncomplicated cystitis?

A

250mg po daily x 3 days

31
Q

what doses of amoxicillin/clavulanate for acute uncomplicated cystitis?

A

500mg po q8h

32
Q

what doses of cefpodoxime for acute uncomplicated cystitis?

A

200mg po BID x 5-7 days

33
Q

what non pharmacological recommendation can be given for UTIs?

A
  1. increase voiding
  2. drink cranberry juice to acidify urine
  3. consume more vitamin C
  4. lactobacillus probiotics
34
Q

what drug can you use for bladder analgesia for UTI?

A

phenazopyridine 200mg po TID x 3 days (max)

35
Q

what are the disadvantages of phenzopyridine?

A
  1. discolor urine and sclera
  2. stain clothes and contact lenses
  3. masks symptoms of UTI
  4. contraindicated in renal/hepatic impairment
36
Q

what changes in terms of treatment when the patient has complicated cystitis vs uncomplicated cystitis?

A

duration of therapy is longer (7-14 days)

37
Q

what is the length of treatment of cystitis if patient is pregnant and symptomatic?

38
Q

which antibiotics can be used for UTI’s in pregnancy?

A

beta lactams: amox/clav & cefpodoxime
nitrofurantoin
fosfomycin

39
Q

what the antibiotic doses for pregnant patients with UTIs?

A
  1. amoxicillin/clavulanic acid 500mg po q8h x 7-14 days
  2. cefpodoxime 200mg po bid x 7-14 days
  3. nitrofurantoin 100mg po bid x 7-14 days
  4. fosfomycin 3g po single dose
40
Q

why should you not use fluroquinolones in pregnant women?

A

causes inhibition of bone development in neonates

41
Q

why not use tetracyclines in pregnant women?

A

inhibit teeth/long bone developement

42
Q

why not use SMX/TMP

A

spinal chord defect -1st trimester

kericterus - 3rd trimester

43
Q

how often should you follow up with a pregnant woman after therapy

A

2 weeks after and every month until birth of child

44
Q

what duration should UTI treatment be given for a man

A

10-14 days not short term.

45
Q

which agents can be used in men with cystitis?

A
  1. SMX/TMP
  2. Levofloxacin
  3. Ciprofloxacin
46
Q

what dosing for SMX/TMP for cystitis in men?

A

1 DS tab po BID x 10-14 days

47
Q

what dosing for levofloxacin for cystitis in men?

A

250mg po qd x 10-14 days

48
Q

what dosing for ciprofloxacin for cystitis in men?

A

250mg po bid x 10-14 days

49
Q

what are the signs and symptoms of catheter associated UTI?

A 
fevers
rigors
altered mental status
flak pain
CVA tenderness
acute hematuria
pelvic discomfort
50
Q

how do you diagnose catheter associated UTI?

A
  1. sx of UTI with no other identifiable source AND

2. >= 10^3 cfu/ml isolated from catheter specimen

51
Q

how do you treat catheter -associated UTI

A
  1. Remove infected catheter.
  2. if short term indwelling catheter (30 days)
    a. symptomatic: re-catheterize w/ new, sterile cathter. if existing catheter present of >= 2 weeks and initiate systemic antibiotics.
52
Q

what agents can be used for mild-moderate pyelonephritis (outpatient)?

A
  1. SMX/TMP
  2. fluroquinolones: cipro/levofloxacin
  3. beta lactams
  4. doxycycline
53
Q

what are the doses for agents used for outpatient treatment of pyelonephritis?

A
  1. SMX/TM: 1 ds tab po BID x 14 days (+ Ceftriaxone 1g IV)
  2. ciprofloxacin 500mg po bid x 7-14 days
  3. levofloxacin 500-750mg po qd x 7-14 days
  4. cipro/levo dose above +intial dose ciprofloxcin 400mg IV x 1 dose
  5. cipro/levo dose above +intial dose ceftriaxone 1g IV x 1 dose.
  6. beta lactams
  7. doxycycline 100mg po bid x 14 days
54
Q

what agents can be used for severe pyelonephritis (inpatient)?

A
  1. community acquired: ceftriaxone, aminoglyside + ampicillin
  2. Nosocomial: peperacillin/tazobcatam, cefepime, ceftazidime, meropenem
    tx for 10-14 days
55
Q

what are the doses for agents used for inpatient treatment of pyelonephritis?

A
  1. ceftriaxone 1g IV q 24 h
  2. gentamycin 5mg/kg + ampicillin 1-2 g IV q6h
  3. tobramycin 5mg/kg + ampicillin 1-2 g IV q6h
  4. piperaci/taz 3.375g IV q6h
  5. cefepime 1g IV q12h
  6. ceftazadime 2g IV q 12h
  7. meropenem 500mg q6h or 1g IV q8h

duration 10-14 days and may change to PO once patient stabilizes.

56
Q

which agents can you used for acute prostatitis?

A
  1. SMX/TMP
  2. cipro
  3. Levofloxacin
  4. cephalosporins
  5. amoxicillin/clavulanic acid
57
Q

what are the doses for the agents used to treat acute prostatitis

A
  1. SMX/TMP: 1 DS tab po q 12h x4 weeks
  2. ciprofloxacin: 500mg po q12h x4 weeks
  3. Levofloxacin: 500mg po qd x4 weeks
  4. cephalosporins 4 weeks
  5. amoxicillin/clavulanic acid 500mg po q8h x 4 weeks
58
Q

what medication can you have for asymptomatic bacteriuria for a pregnant woman

A
  1. amoxicillin 500mg po q12h x 3-7 days
  2. cephalexin 250mg po q6h x 3-7 days
  3. nitrofurantoin 100mg po BID x 3-7 days
  4. fosfomycin 3 grams po x 1 dose
59
Q

what are some ways to prevent UTIs?

A
  1. wipe front to back
  2. adequate hydration/fluid intake 6-8 glasses per day
  3. void frequently
  4. post-coital urination and single dose antibiotic
  5. topical estrogen for post menopausal woman
  6. avoid coffee, tea, carbonated drinks, etch
  7. dont douche
  8. avoid diaphragm use
  9. drink cranberry juice
  10. wear undergarments
60
Q

post-coital prophylaxis for UTIs

A
  1. SMX/TMP: 1 SS tab PO x 1
  2. nitrofurantoin: 50-100mg po x 1
  3. cephalexin: 250mg po x 1
  4. ciprofloxacin: 125mg po x 1
  5. norfloxacin: 200mg po x 1
61
Q

which medications can you use for asymptomatic bacteriuria in pregnancy?

A

amoxicillin 500mg po q12h
cephalexin 250mg po q6h
nitrofurantoin 100mg po bid
fosfomycin 3g po x 1

Therapeutics (23 decks)

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