Urinary Tract infections

Question 1

What are the host factors in UTIs?

Answer 1

repeated UTIs that alter bladder endothelium, girls have shorter urethras, incomplete bladder emptying, pregnancy

Question 2

What are behavioral factors that affect UTIs?

Answer 2

STIs and resisting urge to void

Question 3

What are microbial factors with UTI

Answer 3

E coli attaching to bladder mucosa

Question 4

What are the antibiotics used to treat UTIs?

Answer 4

bactrim, nitrofuratoin, fluoroquinolones, cephalosporins, and PCNS

Question 5

Does cranberry juice help with UTIs?

Answer 5

decreases incidence of symptomatic UTIs

Question 6

What is a pain med for UTIs?

Answer 6

phenazopyridine

Question 7

What are the goals of treatment in a UTI?

Answer 7

Erradicate causitive organism, relieve symptoms, prevent recurrence

Question 8

What is the rational drug selection for UTI drug therapy?

Answer 8

needs gram negative coverage; first choice is bactrim, i if allergic to sulfa, other choice is cipro. Second line choice is cephalosporin. Nitrofurantoin is also option

Question 9

What is the length of treatment for UTI?

Answer 9

Generally 3 days; 10 days in children or others with diabetes, immunosuppressed, really symptomatic etc.

Question 10

What are the resistance patterns present with UTI?

Answer 10

E coli resistance to bactrim is 15 to 20 percent;
same level of resistance is reported for cipro and levofloxacin;
amoxicillin not recommedned because up to one thrid of UTI organisms are resistant to it.

Question 11

What are the cost considerations in UTI treatment?

Answer 11

Bactrim is cheapest, generic cipro also cheap

Question 12

What is the rational drug selection for children with UTIs?

Answer 12

get specimen with catheter, treat for 10 days with something like rocephin untiil afebrile; do a follow up culture

Question 13

What are UTI considerations for older adults?

Answer 13

risk for asymptomatic UTI

Question 14

What are the UTI considerations for males?

Answer 14

enlarged prostate increases risk fo UTI

Question 15

What are UTI considerations during pregnancy

Answer 15

asymptomatic bacteriuria and routine screening

Question 16

what are montioring considerations for UTI?

Answer 16

in women if symptoms persist after 48 hours get a urine culture; in people with recurrent UTI get a urine culture and do a post treatment urinalysis; in children under 5 do a culture, a re-culture after treatment, and maybe radiological workup; in pregnany women do a workup every 2 weeks until delivery

Question 17

What is the outcome evaluation for UTIs?

Answer 17

in children under 5, consider anatomical issues like vesicoureteral reflux; in adults consider urology referral with gross hematruia, symptoms of obstruction, persistant UTI, symptoms in pregnant woman, and fever and dehydration

Question 18

What is patient education for UTIs

Answer 18

Take meds as directed and finish full dose of antibiotics; Lifestyle changes like drinking cranberry juice, dont use spermacides or diaphragms, void after intercourse, drink 2 L of fluid a day, don’t resist urge to void