UTI

Question 1

First-line for cystitis in women

Answer 1

PO co-trimoxazole 800/160mg BD x 3d
OR
PO nitrofurantoin 50mg 4 times a day x 5d
OR
PO fosfomycin 3g single dose

If complicated cystitis, extend to 7-14 days. Fosfomycin dose becomes 3g EOD x 3 doses.

Question 2

PO antibiotics for community acquired pyelonephritis in women

Answer 2

PO ciprofloxacin 500mg BD x 7d
OR
PO levofloxacin 750mg daily x 5d

Question 3

First-line for UTI in men with concern for prostatitis/ pyelonephritis

Answer 3

PO ciprofloxacin 500mg BD x 10-14d
OR
PO co-trimoxazole 800/160mg BD x 10-14d

Treat for 6 weeks if prostatitis confirmed.

Question 4

Treatment for UTI in pregnancy

Answer 4

As per non-pregnant women or AST but avoid drugs C/I in pregnancy

Question 5

Drugs to avoid in pregnancy

Answer 5

• Co-trimoxazole (1st & 3rd trimester)
• Ciprofloxacin
• Nitrofurantoin (at term ~ 38-42 weeks)

Question 6

Empiric treatment for catheter associated UTI

Answer 6

IV imipenem 500mg q6h
OR
IV meropenem 1g q8h
OR
IV cefepime 2g q12h +/- IV amikacin 15mg/kg (1 dose)

Treat for 7d if fever go down within 3d; if not, 10-14d

Question 7

Treatment for mild catheter associated UTI

Answer 7

PO/IV levofloxacin 750mg daily x 5d

Question 8

Treatment for women ≤ 65 y/o with CA-UTI w/o upper UTI symptoms after an indwelling catheter has been removed

Answer 8

PO co-trimoxazole 800/160mg bid x 3d

Question 9

What constitutes a Healthcare associated UTI

Answer 9

• hospitalised patients
• pt underwent urologic procedure in last 6 months
• has indwelling catheter

Question 10

Causative pathogen for CA-UTI in Short-term catheterisation (<7 days)

Answer 10

single organisms e.g. E.coli, klebsiella, pseudomonas

Question 11

Causative pathogen for CA-UTI in Long-term (>28 days) catheterisation

Answer 11

polymicrobial (2-3 organisms)

Question 12

Do patients with CA-UTI commonly present with systemic symptoms?

Answer 12

No, assess for other causes

Question 13

Duration of tx for pregnancy UTI

Answer 13

Cystitis/ASB: 4-7d;
Pyelonephritis: 14d

Question 14

IV antibiotics for community acquired pyelonephritis in women

Answer 14

Cipro 400mg BD
OR
Cefazolin 1g q8h
OR
Augmentin 1.2g q8h
OR
Gentamicin 5mg/kg (IM also ok)

Question 15

IV Treatment for nosocomial pyelonephritis (include duration)

Answer 15

Cefepime 2g BD +/- amikacin 15mg/kg/d

Imipenem 500mg QDS

Meropenem 1g TDS

x 7-14d

Question 16

PO Treatment for nosocomial pyelonephritis

Answer 16

Levo 750mg daily
OR
Cipro 500mg BD

x 7-14d

Question 17

Adjunctive therapy for urinary symptoms

Answer 17

Phenazopyridine (Urogesic) 100-200mg TDS
- for symptomatic relief (dysuria)

Question 18

ADR & C/I for phenazopyridine

Answer 18

• Do not use in G6PD deficiency
• ADR: nausea, vomiting, orange-red discolouration of urine and stool

Question 19

Tx for community acquired UTI in men with no concern for prostatitis/ pyelonephritis

Answer 19

As per complicated cystitis in women