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Clinical 2.0 > UTI > Flashcards

UTI Flashcards

1
Q

most common pathogens in acute cystitis

A

ecoli >80%
staph saprophiticus
klebsiella
proteus mirabillis

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2
Q

risk factors for acute cystitis

A 
female 
previous UTI 
sexually active 
pregnancy 
post meno pause 
diabtes 
IC 
obstruction 
urinary reflux
incontinence 
urinary catherter
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3
Q

what do you do if men have a UTI

A

not common have to check for causes such as sti enlaged prostat..

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4
Q

signs and symptoms

A

dysuria - pain when peeing
frequency
urgency
hematuria

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5
Q

what are warning signs of something more than a uti

A

fever
flank pain
vaginal discharge
new sexual partner

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6
Q

presentation in the elderly

A

confusion
GI
loss of appetie

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7
Q

when would you do a urine culture/susceptibilty test

A

recurrent or complicated cases
children
pregnancy women
males

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8
Q

some diagnositic tests in urinalysis

A 
microscopic bacterial counts
dipstick for nitrite
leukocyte esterase
microscopic pyuria
hematuria
proteinuria
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9
Q

nitrefurantoin dosing

A

100mg q12h x 5 days

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10
Q

when to use nitrofurantoin

A

mild-mod cystitis
ecoli, klebsiella, saureus, enterococcus
NOT proteus or systemic infection

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11
Q

advantages of nitrofurantoin

A

min resistance low collateral resistance

well tolerated

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12
Q

disadvantages of nitrofurantoin

A

some rare serious advere effects

potential lower bacterial cure rates

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13
Q

nitrpfurantoin CI

A

crcl<30 not recommended
pregnany women term >36 weeks
neonates <1mon
G6PD deficiency - hemplytic anemia

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14
Q

adverse effects of nitrofurantoin

A

hematological, pulmonary and hepatic toxicity

increased risk in elederly renal dysfunction or prolonged use

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15
Q

duration of tmpsmx

A

use the doiuble strength tablet for 3 days

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16
Q

who to use tmpsmx in

A

mild-mod cystitis

ecoli, klebsiella, proteus, saureus particularly if ecoli resistance <20%

17
Q

disadvantages of tmp smx

A

increasin resistance to ecoli
some concern with collateral resistance
high rate of potentially serious adveres effects - rash, hypersensitivity

18
Q

tmpsmx CI

A

crcl<10
pregnant
hemolytic anemia

19
Q

alternatives for uti

A

amoxclav high dose for 7 days

cephalexin high dose for 7 days

20
Q

fosfomycin tromethamine dose

A

3g x 1 dose

21
Q

use for fosfomycin tromethamine

A

mid-mod cystitis associated with exoli or efaecalis

22
Q

benefits of fodfomycin tromethamine

A

rare resistance

23
Q

disadvantages of fosfomycin tromethamin

A

similar clinical efficacy potentialy lower bacterial efficacy thabut way higher cost

24
Q

which drugs do we try reserve use for uti

A

fluoroquinolones

25
Q

dosing for fluoroquinolones

A

use the low dose for 3 days

26
Q

when to use fluoroquinolones

A

mod-severe complicated including pyelonephritis or suspected resistance

27
Q

advantage of fluoroquinolones

A

90% bacterial and clinical efficacy
well studied
cidal work quickly

28
Q

disadvantage of fluorquinolones

A

collateral resistance

CI in children and pregnany women

29
Q

when cant you use norfloxacin

A

systemic infections limited to UTI

30
Q

what do you have to do differently in a pregnant woman and children with a uti

A

get a urine culture
confirm treatmetn success with follow up culture
children - work up for pyelonephritis, underlying medical condition and anatomical abnormality

31
Q

treatment options for acute cystitis in pregnant women

A

nitrofurantoin
amoxclav
cephalexin
all for 7 days

32
Q

general treatment for children

*normally will just follow susceptibility results

A 
amoxclav
cephalexin 
nitrofurantoin
tmpsmx
gent + amp/ceftriaxone for pyelonephritis iv
33
Q

essential patient counselling for acute uncomplicated cystitis

A

adherence
analgesics fo symptoms
follow up if symptoms excedd 2-3 days or relapse

34
Q

mechanism for cranberry juice

A

active compound inhibit bacterial adherence to uroepithelium
lots of variability amoung products
not effective for treatment limited data for prevention

35
Q

what is considered a relapse

A

initial organism within 2 weeks

36
Q

approach to a relapse

A

urine culture to identify potentially resistant pathogen
work up for pyelonephritis
retreat as describe for acute cystitis
consider 10-14 days

37
Q

what is considered recurrence

A

2 infections within 6 months or >=3 within 12 months

Clinical 2.0 (24 decks)

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