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Spring 15 - Pharm Unit III > UTI > Flashcards

UTI Flashcards

1
Q

Risk Factors for UTI

A
  • age, gender
  • neuro dysfunction, incontinence
  • instrumentation or obstruction
  • prior hx
  • sexual activity, spermicide/diaphragm use
  • pregnancy, postmenopausal
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2
Q

Lower UTI Definition

A

cystitis (bladder)

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3
Q

Upper UTI Definition

A

pyelonephritis (kidneys)

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4
Q

Uncomplicated UTI Definition

A

UTI in otherwise healthy female with no structural or functional abnormalities of urinary tract

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5
Q

Complicated UTI Definition

A
  • most often assoc w/ predisposing lesion in urinary tract

- also DM, age > 65, pregnancy, immunosuppression, male

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6
Q

Recurrent UTI Definition

A

3 or more UTI per year

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7
Q

Reinfection

A

caused by new organism

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8
Q

Relapse

A

development of repeated infections caused by same initial organism

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9
Q

Asymptomatic Bacteriuria

A

significant bacteriuria (>100,000 bacteria/mL) in the absence of sxs (common > 65)

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10
Q

Cystitis Clinical Presentation

A
  • frequency, urgency, painful urination
  • low back or abdominal pain
  • suprapubic tenderness
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11
Q

Pyelonephritis Clinical Presentation

A
  • systemic sxs: fever, rigors, HA, N/V, malaise
  • localized flank pain, CVA tenderness
  • frequency, urgency, painful urination
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12
Q

UA Findings in UTI

A
  • > 100,000 bacteria/mL in women (> 1000 in men)
  • > 10 WBC/mm^3
  • positive leukocyte esterase
  • positive nitrites
  • hematuria
  • quantitative UC (>100,000 bacteria/mL)
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13
Q

Common Pathogens for Community Acquired UTI

A
  • E coli (85%)
  • Proteus, Klebsiella
  • Staph. saprophyticus
  • Enterococcus
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14
Q

Common Pathogens for Complicated/Nosocomial UTI

A
  • E. coli (50%)
  • Enterococcus
  • Pseudomonas
  • Staph
  • Proteus, Klebsiella
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15
Q

Which patients should get a urine culture?

A
  • complicated cystitis
  • cystitis in pregnancy
  • cystitis with clinical failure
  • pyelonephritis
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16
Q

When should complicated cystitis and pyelonephritis get a urine culture?

A

before antibiotic is started

+/- 1-2 weeks after tx is finished

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17
Q

When should cystitis in pregnancy get a urine culture?

A

before antibiotic is started AND

1-2 weeks after tx is finished

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18
Q

When should cystitis with clinical failure get a urine culture?

A

after clinical failure AND

2 weeks after re-treatment is finished

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19
Q

UTI Tx Goals

A
  • prevent or treat systemic consequences of infx
  • eradicate the causative organisms
  • prevent infx recurrence
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20
Q

Considerations for Abx Choice in UTI Tx

A
  • UTI category
  • complicating factors
  • local sensitivity patterns
  • pt allergies
  • concurrent meds
  • cost
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21
Q

Pathogens in Acute Uncomplicated Cystitis

A
  • E. coli
  • Proteus, Klebsiella
  • Staph. saprophyticus
  • Enterococci
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22
Q

Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20%

A

-TMP/SMX 1 DS po bid x3 days

23
Q

Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance < 20% with Sulfa Allergy

A
  • nitrofurantoin 100 mg po bid x5 days OR

- fosfomycin 3 gm po x1

24
Q

Tx of Acute Uncomplicated Cystitis with Local E. Coli Resistance >20% or Sulfa Allergy

A
  • cipro 250 mg bid, cipro ER 500 mg qd, levo 250 mg qd, moxi 400 mg qd x3 days OR
  • nitrofurantoin or fosfomycin
25
Q

How does fosfomycin compare to TMP/SMX or FQs?

A

-less effective vs. E. coli

26
Q

Why must caution be used with nitrofurantoin?

A

chronic use assoc w/ pulm toxicity

27
Q

What is the MC AE of fosfomycin?

A

headache

28
Q

Pathogens in Pregnancy Cystitis

A
  • E coli

- S saprophyticus

29
Q

Tx of Pregnancy Cystitis

A
  • TMP/SMX x7 days
  • Amox/clav x7 days
  • Cephalexin x7 days
  • Nitrofurantoin x7 days
30
Q

Which drug should be avoided within 2 weeks of due date in pregnancy cystitis and why?

A
  • TMP/SMX

- potential increase in kernicterus risk for newborn

31
Q

Pathogens in UTI Pt with STD Risk Factors

A

C. trachomatis

32
Q

Tx of C. trachomatis UTI

A
  • azithromycin 1 gm po x1

- alt: doxycycline 100 mg po bid x7 days

33
Q

Tx of Recurrent Cystitis in Young Women

A
  • eradicate then TMP/SMX SS qd long term
  • or TMP/SMX 2 DS x1 at sx onset
  • or TMP/SMX 1 DS x1 after sex
34
Q

What is the problem with daily TMP/SMX tx of recurrent cystitis?

A

risk of bacterial resistance to abx

35
Q

Tx of Recurrent Cystitis in Postmenopausal Women

A
  • treat as uncomplicated UTI
  • TMP/SMX 1 DS po bid x3 if no E. coli resistance
  • cipro, levo, moxi x3 days if resistance
36
Q

Pathogens of Male UTIs

A
  • E coli

- Proteus, Klebsiella

37
Q

Tx of Male UTIs

A
  • TMP/SMX x10-14 days

- quinolone x10-14 days

38
Q

Tx of Acute Pyelonephritis in Outpatients

A
  • quinolone (cipro 500 mg bid, cipro ER 1000 mg qd, oflox 400 mg bid, moxi 400 mg qd) PO x7 days or levo 750 mg x5 days
  • alt: amox/clav, cephalexin, TMP/SMX
39
Q

Tx of Hospitalized Acute Pyelonephritis Patients

A
  • quinolone x14 days
  • amp + gent
  • ceftriaxone
  • piperacillin/tazobactam
40
Q

What is important to give when treating a hospitalized pyelonephritis patient?

A

-IV abx until pt afebrile 24-48 hr then complete course with PO meds

41
Q

Risk Factors for Cystitis in Males

A
  • uncircumcised
  • sexual partner with vaginal colonization
  • MSM
42
Q

What typically causes cystitis in men?

A

urinary tract abnormality

43
Q

What is not recommended for tx of UTI in men?

A

-single dose and 3 day regimens

44
Q

What is phenazopyridine (pyridium)?

A
  • urinary analgesic

- OTC

45
Q

What is the problem with phenazopyridine?

A

-may mask signs and sxs of UTIs not responding to abx tx

46
Q

AEs of Phenazopyridine

A
  • HA
  • dizziness
  • stomach cramps
  • nay color urine orange or red, stain clothing
47
Q

Precautions for Phenazopyridine

A

-do not use with CrCl < 50 mL/min

48
Q

Dose of Phenazopyridine

A

-200 mg tid pc x2 days when used with abx

49
Q

Role of Hydration in UTI Tx

A
  • rapid dilution of bacteria
  • removal of infected urine by increased voiding
  • may actually dilute the antibacterial properties of urine
50
Q

Role of Cranberry Juice in UTI Tx

A
  • large amounts of cranberry juice may increase antibacterial activity of urine and prevent UTIs
  • does not appear to play a significant role in tx
51
Q

Hygiene UTI Prevention Options

A
  • proper wiping

- void after sex

52
Q

Role of Lactobacillus Probiotics in UTI Prevention

A

-may help prevent UTIs in females by decreasing vaginal pH and decreasing E coli colonization

53
Q

Role of Topical Estrogen Replacement in Postmenopausal Women for UTI Prevention

A
  • may help prevent recurrent UTIs

- after 1 month, found increase in Lactobacillus, decrease in pH and E coli colonization

Spring 15 - Pharm Unit III (12 decks)

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