UTI Abx Flashcards
asymptomatic bacteriuria tx
usually none needed
cystitis tx, first line
nitrofurantoin
TMP-SMX
fosfomycin
Cystitis tx, second line
oral beta lactams:
- amoxicillin
- cefpodoxime
- cefdinir
- cefadroxil
cystitis tx, third line
fluoroquinolones (more adverse effects make these third line) - ciprofloxacin - levoflaxacin - ofloxacin adverse effects: - tendinitis and rupture - peripheral neuropathy - CNS effects Moxifloaxacin NOT recommended
nitrofurantoin
gram + and - P. aeruginosa and proteus resistant disrupts protein and DNA synthesis no systemic action contraindicated in G6PD deficiency shoundnt be taken if pyelonephritis present
fosfomycin
gram + and -
cell wall synthesis inhibitor, inhibits enolpyruvvate transferase
safe to use in pregnancy
shouldn’t be taken if suspicious of pyelonephritis
amoxicillin
amiopenicillin
cefpodoxime
3rd gen cephalosporin
cefdinir
3rd gen cephalosporin
cefadroxil
1st gen cephalosporin thats also effective against gram + and -
Cystitis tx resistance
don't use ampicillin and amoxicillin for uncomplicated cystitis Use ertapenem (carbapenem) if resistance suspected
pyelonephritis tx, first line
fluoroquinolones (ciprofloxacin, levoflaxacin)
fluoroquinolones for pyelonephritis
ciprofloxacin levoflaxacin administered with broad spectrum abx: - ceftriaxone - gentamicin or tobramycin (aminoglycosides)
Aminoglycosides for pyelonephritis
works against gram - and P. aeruginosa protein synthesis inhibitors cleared by kidneys high dose side effects: - renal toxicity - CNVIII toxicity (vertigo, hearing loss) - neuromuscular blockade
Pyelonephritis tx, second line
TMP-SMX
oral beta lactams
aztreonam
used in fluoroquinolone hypersensitivity or resistance
Aztreonam
pyelonephritis second line tx mono-bactam, no beta lactam hypersensitivity no activity against gram + or anaerobes cell wall synthesis inhibitor can cause neutropenia in children
Complicated cystitis tx
ciprofloxacin levoflaxacin - both cover P. aeruginosa - both fluoroquinolones NOT moxifloxacin
complicated pyelonephritis tx, mild
ceftriaxone
ciprofloxacin
levoflaxacin
aztreonam ( monobactam, no beta lactam hypersensitivity )
complicated pyelonephritis tx, severe
beta lactam + beta lactamase inhibitor
a carbapenem
complicated cystitis caused by gram +
ampicillin or amoxicillin
usually due to E. Faecalis or E. faecium
phenazopyridine
urinary analgesic for complicated cystitis
colors urine orange/red
beta lactams for first line tx or complicated pyelonephritis
cefepime (4th gen) piperacillin ( works against aeruginosa) + tazobactam Ceftolozane (5th gen) + tazobactam Ceftazidime (3rd gen)+ avibactam meropenem imipenem doripenem
beta lactamase inhibitors
tazobactam and avibactam
resemble beta lactam molecules with weak antimicrobial action
inhibits action of ambler class A beta lactamases produced by E. coli and Klebsiela
poor inhibitors of class C beta lactamases produced by enterobacter and aeruginosa
complicated first line pyelonephritis tx, Carbapenems
imipenem (can cause seizures and rashes)
doripenem
meropenem
ertapenem (against P aeruginosa, longest half-life)
broad spectrum against gram +, - and anaerobes
resistance to beta lactamases
inhibits transpeptidases
