UTI

Question 1

1st line UTI tx options

Answer 1

Sulfamethoxazole/trimethoprim F3D
Nitrofurantoin F5D
Fosfomycin F1D

Question 2

Sulfamethoxazole/trimethoprim side effects

Answer 2

may cause n/v/d (3-4%, take w food & full glass water)
monitor for rash (SJS), jaundice, arthralgia, SOB
other: hyperkalemia, myelosuppression, renal impairment

Question 3

Nitrofurantoin side effects

Answer 3

(Macrobid) Headache, nausea, flatulence, loss of appetite (take w food). Brown discoloration of urine. DDI: antacids decrease absorption.

Question 4

Difference between Nitrofurantoin monohydrate/macrocrystals and macrocrystals

Answer 4

The monohydrate/macrocrystal formulation may be better tolerated than the macrocrystal formulation.
UTI doses are different: 50–100 mg Q6H for macrocrystals, 100 mg Q12H PO for monohydrate/macrocrystal (brand name Macrobid).

Question 5

Fosfomycin side effects

Answer 5

(Monurol) Diarrhea, headache, nausea, vaginitis.

Question 6

2nd line UTI tx alternatives

Answer 6

Cipro/Levo/Norfloxacin F3D or Cephalexin F7D

Question 7

Pregnancy UTI tx options

Answer 7

3-7 days of Amox, Amoxi/Clav, Cephalexin, Nitrofurantoin, Fosfomycin

Question 8

When are UTIs considered recurrent?

Answer 8

2 or more in 6 months
3 or more in 12 months

Question 9

Tx options for recurrent UTIs?

Answer 9

Post-coital prophylaxis or long-term low-dose prophylaxis

Question 10

Sulfamethoxazole/trimethoprim dose

Answer 10

800/160 mg (2 regular-strength tablets or 1 double-strength tablet) Q12H F3D

Question 11

Nitrofurantoin monohydrate/macrocrystals dose

Answer 11

(MacroBID) 100 mg Q12H F5D

Question 12

Fosfomycin dose

Answer 12

(Monurol) one 3 g sachet × 1 dose

Question 13

What to avoid in pregnancy UTI

Answer 13

Nitrofurantoin near term (3rd T)
Septra in 1st T and last 6 weeks
flouroquinolones

Question 14

Fosfomycin counselling points

Answer 14

add ½ cup of cold water, stirr to dissolve and drink immediately on an empty stomach or at least 2-3 hours after food