UTI Flashcards
Classification of UTIs
lower and upper
Define Lower UTI
infection of the bladder (cystitis)
Define Upper UTI
infection involving the kidneys (pyelonnephritis)
Uncomplicated UTI
no structural or functional abnormalities
Complicated UTI
Predisposing lesion of the urinary tract- congenital abnormality or distortion of urinary tract, stone, indwelling catheter, prostatic hypertrophy, obstruction or neurological deficit that interferes with normal urinary flow
What types of UTI can males have?
males only have complicated
Predisposing Factors
Age
Gender
Pregnancy
Use of Spermicides and diaphragms
Instrumentation of urinary system
Urinary tract obstruction- including drugs like anticholinergics
Incomplete bladder emptying
Neurologic dysfunction – stroke, diabetes, spinal cord injury
Vesicoureteral reflux
Renal disease
Which organisms most commonly cause UTI?
S. pneumoniae
S. aureus
E. coli
Enterococcus species
Pseudomonas aeruginosa
What is the most common etiology in uncomplicated UTI?
E.coli 80%
What are other common etiology in uncomplicated UTI?
Staph saprophyticus, K. pneumoniae, Proteus spp., Enterococcus spp.
What are etiology in complicated UTI?
E.coli 50%
Staph saprophyticus, K. pneumoniae, Proteus spp., Enterococcus spp.
How to diagnosis UTI?
urinalysis - bacteriuria and pyuria
urine culture
you have to have enough in the urine to get the diagnosis
Tests for urine dipsticks
for nitrite
- not all bacteria convert nitrates to nitrites
for leukocyte esterase
- esterase activity for WBC
Clinical Presentation lower UTIs
dysuria, urgency, frequency, nocturia, suprapublic heaviness/pain, gross hematuria
Clinical Presentation upper UTIs
flank pain, fever nausea, vomiting, malaise, costovertebral tenderness
What to consider for treatment for UTIs?
Site of infection – cystitis vs pyelonephritis
Renal function
Causative organism
Concurrent disease
Ability to penetrate urine or kidneys
Drug interactions
Adverse effects and allergies
cost
What is the first line for UTI uncomplicated?
TMP/SMX
TMP
nitrofurantoin
Which antibiotic is hepatic metabolized?
erythromycin
What antibiotics hepatically eliminated?
moxifloxacin
How long is nitrofuratoin used for?
5 days
what is the dose for TMP/SMX for uncomplicated UTI
1 DS bid for 3 days
What is the dose for TMP for uncomplicated UTI?
100 mg BID
200 mg daily
for 3 days
What are some alt for first line uncomplicated UTI?
cephalexin
fosfomycin
What is the dose for cephalexin for uncomplicated UTI?
250 mg QID for 7 days
What is the dose for fosfomycin for uncomplicated UTI?
3 g single dose
What is the second line for uncomplicated UTI?
amoxicillin
norfloxacin
ciprofloxacin
What is the dose for amoxicillin for uncomplicated UTI?
500 mg TID for 3-7 days
875 mg BID for 3-7 days
What is the dose for norfloxacin for uncomplicated UTI?
400 mg BID for 3 days
What is the dose for ciprofloxacin for uncomplicated UTI?
250 mg BID
500 mg ER daily
for 3 days
What is factors looked at treatment of recurrence?
Culture
Re-assess for upper tract infection
Re-treat for 7 to 14 days
Same antibiotic choices, however tailor based on C&S
Define frequent recurrences
short course self treatment at onset of symptoms if less than 3 infections per year
Treatment opinions for frequent recurrences
TMP/SMX
TMP
Macrobid
Second line - FQ
Dose for frequent recurrent UTI for TMP/SMX
1 tab or 1/2 DS tab
qhs 3 times weekly or post-coital if associated with intercourse
Dose for frequent recurrent UTI for TMP
100 mg qhs
or post coital
Dose for frequent recurrent UTI for macrobid
100 mg qhs
or post coital
Dose for frequent recurrent UTI for FQ
3 times weekly or every other day or post coital
List some non-antibiotic therapy
cranberry juice
topical (vaginal) estrogen
What are factors needed for pharmacist prescribing?
not first episode
not pregnant
uncomplicated
not relapse
Which antibiotics have poor renal tissue concentration?
cefotaxime and nitrofurantoin
Explain factors for uncomplicated UTI in men
uncommon but an occur
urine cultures recommended
length is longer 2 wks
What are the opinions for non-obstructive mild pyelonephritis?
TMP/SMX (14 d)
TMP (14d)
norfloxacin
ciprofloxacin (7d)
levofloxacin (5d)
amox/clav (10-14d)
What are the opinions for non-obstructive severe pyelonephritis?
Gentamicin + ampicillin
ciprofloxacin
levofloxacin
ceftriaxone + gentamicin
Dose for gentamicin for pyelonephritis for gentamicin
4-7 mg/kg q 24 h
Dose for gentamicin for pyelonephritis for ampicillin
1-2 g q 4-6 h (IV)
Dose for gentamicin for pyelonephritis for ciprofloxacin
400 mg IV q 12 h
Dose for gentamicin for pyelonephritis for levofloxacin
250-500 mg q 24h
Dose for gentamicin for pyelonephritis for Ceftriaxone
1-2 g IV q24h
What is the etiology for bacterial prostatitis?
e.coli 75%
other gram negative organisms
What is needed for diagnosis for bacterial prostatitis?
urine culture
in chronic prostatitis
quantitative localization culture
List some symptoms of acute bacterial prostatitis
fever, chills, tenderness/pain, malaise, myalgia, frequency, urgency, nocturia and retention
List some symptoms of chronic bacterial prostatitis
urinating difficulty, low back pain, perineal and suprapubic pressure
Define bacterial prostatitis
Inflammation of the prostate gland and surrounding tissue due to infection
Reflux of infected urine into prostate gland
Treatment for acute bacterial prostatitis
TMP/SMX, TMP, norfloxacin, levofloxacin , ciprofloxacin
Treatment for severe bacterial prostatitis
ampicillin or ceftriaxone IV PLUS gentamicin or tobramycin or amikacin
Duration for acute bacterial prostatitis
Total duration minimum 2 weeks; total course should be 4 weeks to prevent chronic infection
Treatment for chronic bacterial prostatitis
4 – 12 weeks
Fluoroquinolones have better cure rate than TMP/SMX
More difficult to get antibiotic penetration into prostate
First line for UTI in pregnancy
cephalexin
amoxicillin
nitrofurantoin
Second line for UTI in pregnacy
TMP/SMX
TMP
avoid in first trimester and in last 6 weeks of pregnacy
Dose for UTI for pregnancy for cephalexin
250-500 mg QID 7 days
Dose for UTI for pregnancy for amoxicillin
500 mg TID 7 days
Dose for UTI for pregnancy for nitrofurantoin
100 mg bid x 5 days
When should nitrofurantoin be avoided in pregnancy?
Avoid at term (36-42 weeks gestation and during labor and in neonates)
When should TMP/SMX or TMP be avoided in pregnancy?
avoid in first trimester and in last 6 weeks of pregnancy
How does Catheterization and UTI relate?
catheterization increase the rate of UTI
direct route for bacteria
Asymptomatic bacteriuria
Except during pregnancy and/or pre-operative genitourinary procedures, there are no indications for screening or therapy for asymptomatic UTI
there is no benefit for elderly may cause harm
Nitrofurantoin MOA
damages bacterial DNA/proteins
Nitrofurantoin resistance
very slow to develop
Nitrofurantoin spectrum
e. coli
staphylococci
enterococcus faecalis
citrobacter
klebsiella
Nitrofurantoin uses
first line for uncom. cystitis and prophylaxis
do not use for pyelonephritis and prostatitis
Nitrofurantoin AE
gi upset
nausea
headache
darkens urine
Nitrofurantoin rare AE
SJS/TEN
Nitrofurantoin AE with long term use
neuropathy
pulmonary fibrosis
hepatic fibrosis
Fosfomycin MOA
inhibits cell wall formation
bactericidal
Fosfomycin resistance
uncommon
unqiue class
Fosfomycin spectrum
Enterobacteriaceae including ESBL producers, Enterococcus; does not reliably cover P. aeruginosa
Fosfomycin uses
uncomplicated UTI; reserve for allergy or resistance to nitrofurantoin or TMP/SMX; NOT pyelonephritis; considered safe in pregnancy
Fosfomycin AE
GI upset, diarrhea, headaches, hypokalemia
Fosfomycin dosing
3 gram oral powder x 1 dose; dissolve the powder in ½cup water and drink immediately
Nitrofurantoin DI
may increase K combined with spironolactone
