Urogenital Infection

Question 1

What are treatments (medication, dose, duration) for uncomplicated acute bacterial cystitis (non-pregnant)

Answer 1

*- Bactrim (Trimethoprim-sulfamethoxazole) | One tablet (160mg trimethoprim-800mg sulfamethoxazole) | BID for 3 days
- Trimethoprim | 100mg | BID for 3 days
- Nitrofurantoin macrocrystals | 50-100mg | QID for 7 days
- Nitrofurantoin monohydrate macrocrystals | 100mg | BID for 7 days
- Fosfomycin tromethamine | 3g dose (poweder) | single dose
^- Ciprofloxacin | 250mg | BID for 3 days
^- Levoflxacin | 250mg | QD for 3 days
^- Norfloxacin | 400mg | BID for 3 days
^- Gatifloxacin | 200mg | QD for 3 days

• First line
  ^ Avoid Fluoroquinolones as first line treatment to prevent antimicrobial resistance

Question 2

How is pyelonephritis treated outpatient in non-pregnant women (medication class, duration)?

Answer 2

Fluoroquinolones | 5-14 days depending on medication

• Patient with risk factors for MDR gram negative organisms: Initial dose of Ertapenem followed by Fluoroquinolone

Question 3

How is pyelonephritis treated inpatient in non-pregnant women (medication class, duration)?

Answer 3

• Critically ill or suspected obstruction: Antipseudomonal Carbapenem plus Vancomycin
• Non-critically ill:
  
  • Patient with no risk factors for a multidrug-resistant (MDR) gram negative infection: Ceftriaxone, Piperacillin-Tazobactam (Zosyn), Fluoroquinolones
  • Patient with risk factors for MDR: Antipseudomonal Carbapenem
• Duration: 5-14 days depending on medication
• Switch to PO when able
• Hydration! IV or oral

Question 4

Name indications for inpatient treatment of pyelonephritis

Answer 4

Pregnancy
Septic or critically ill
Persistently high fever (>38.4°C/>101°F) or pain
Marked debility
Inability to tolerate PO
Suspected urinary tract obstruction
Non-adherent

Question 5

What are treatments (medication, dose, duration) for asymptomatic bacteriuria or uncomplicated acute bacterial cystitis in pregnant women?

Answer 5

• Amoxicillin | 500mg q8hr or 875mg q12hrs | 5 to 7 days
• Amoxicillin clavulanate | 500mg q8hr or 875mg q12hrs | 5 to 7 days
• Cephalexin | 250mg to 500mg q6hr | 5 to 7 days
• Cefpodoxime | 100mg q12hrs | 5 to 7 days
• Fosfomycin | 3g dose (poweder) | single dose
• • Nitrofurantoin | 100mg q12hrs | 5 to 7 days
• • Bactrim | 800/160mg q12hrs | 3 days
• Avoid in first trimester (birth defects) and at term (kernicterus)

Perform follow-up urine culture for test of cure

Question 6

How is pyelonephritis treated in pregnant women?

Answer 6

• Hospitalization
• Hydration
• IV antibiotics, usually Ceftriaxone (1g IV q24hrs), until afebrile 24-48hrs
• Switch to PO antiboitics when afebrile, complete 10-14 days antibiotics total (IV + PO)
• Follow-up urine culture for test of cure
• Prophylactic therapy until delivery (Nitrofurantoin 50 to 100mg qHS or Cephalexin 250 to 500mg qHS)