UTI Flashcards
most common pathogens in acute cystitis
ecoli >80%
staph saprophiticus
klebsiella
proteus mirabillis
risk factors for acute cystitis
female previous UTI sexually active pregnancy post meno pause diabtes IC obstruction urinary reflux incontinence urinary catherter
what do you do if men have a UTI
not common have to check for causes such as sti enlaged prostat..
signs and symptoms
dysuria - pain when peeing
frequency
urgency
hematuria
what are warning signs of something more than a uti
fever
flank pain
vaginal discharge
new sexual partner
presentation in the elderly
confusion
GI
loss of appetie
when would you do a urine culture/susceptibilty test
recurrent or complicated cases
children
pregnancy women
males
some diagnositic tests in urinalysis
microscopic bacterial counts dipstick for nitrite leukocyte esterase microscopic pyuria hematuria proteinuria
nitrefurantoin dosing
100mg q12h x 5 days
when to use nitrofurantoin
mild-mod cystitis
ecoli, klebsiella, saureus, enterococcus
NOT proteus or systemic infection
advantages of nitrofurantoin
min resistance low collateral resistance
well tolerated
disadvantages of nitrofurantoin
some rare serious advere effects
potential lower bacterial cure rates
nitrpfurantoin CI
crcl<30 not recommended
pregnany women term >36 weeks
neonates <1mon
G6PD deficiency - hemplytic anemia
adverse effects of nitrofurantoin
hematological, pulmonary and hepatic toxicity
increased risk in elederly renal dysfunction or prolonged use
duration of tmpsmx
use the doiuble strength tablet for 3 days
who to use tmpsmx in
mild-mod cystitis
ecoli, klebsiella, proteus, saureus particularly if ecoli resistance <20%
disadvantages of tmp smx
increasin resistance to ecoli
some concern with collateral resistance
high rate of potentially serious adveres effects - rash, hypersensitivity
tmpsmx CI
crcl<10
pregnant
hemolytic anemia
alternatives for uti
amoxclav high dose for 7 days
cephalexin high dose for 7 days
fosfomycin tromethamine dose
3g x 1 dose
use for fosfomycin tromethamine
mid-mod cystitis associated with exoli or efaecalis
benefits of fodfomycin tromethamine
rare resistance
disadvantages of fosfomycin tromethamin
similar clinical efficacy potentialy lower bacterial efficacy thabut way higher cost
which drugs do we try reserve use for uti
fluoroquinolones
dosing for fluoroquinolones
use the low dose for 3 days
when to use fluoroquinolones
mod-severe complicated including pyelonephritis or suspected resistance
advantage of fluoroquinolones
90% bacterial and clinical efficacy
well studied
cidal work quickly
disadvantage of fluorquinolones
collateral resistance
CI in children and pregnany women
when cant you use norfloxacin
systemic infections limited to UTI
what do you have to do differently in a pregnant woman and children with a uti
get a urine culture
confirm treatmetn success with follow up culture
children - work up for pyelonephritis, underlying medical condition and anatomical abnormality
treatment options for acute cystitis in pregnant women
nitrofurantoin
amoxclav
cephalexin
all for 7 days
general treatment for children
*normally will just follow susceptibility results
amoxclav cephalexin nitrofurantoin tmpsmx gent + amp/ceftriaxone for pyelonephritis iv
essential patient counselling for acute uncomplicated cystitis
adherence
analgesics fo symptoms
follow up if symptoms excedd 2-3 days or relapse
mechanism for cranberry juice
active compound inhibit bacterial adherence to uroepithelium
lots of variability amoung products
not effective for treatment limited data for prevention
what is considered a relapse
initial organism within 2 weeks
approach to a relapse
urine culture to identify potentially resistant pathogen
work up for pyelonephritis
retreat as describe for acute cystitis
consider 10-14 days
what is considered recurrence
2 infections within 6 months or >=3 within 12 months
