UTI Abx

Question 1

asymptomatic bacteriuria tx

Answer 1

usually none needed

Question 2

cystitis tx, first line

Answer 2

nitrofurantoin
TMP-SMX
fosfomycin

Question 3

Cystitis tx, second line

Answer 3

oral beta lactams:

• amoxicillin
• cefpodoxime
• cefdinir
• cefadroxil

Question 4

cystitis tx, third line

Answer 4

fluoroquinolones (more adverse effects make these third line) 
- ciprofloxacin
- levoflaxacin
- ofloxacin 
adverse effects:
- tendinitis and rupture
- peripheral neuropathy 
- CNS effects 
Moxifloaxacin NOT recommended

Question 5

nitrofurantoin

Answer 5

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

Question 6

fosfomycin

Answer 6

gram + and -
cell wall synthesis inhibitor, inhibits enolpyruvvate transferase
safe to use in pregnancy
shouldn’t be taken if suspicious of pyelonephritis

Question 7

amoxicillin

Answer 7

amiopenicillin

Question 8

cefpodoxime

Answer 8

3rd gen cephalosporin

Question 9

cefdinir

Answer 9

3rd gen cephalosporin

Question 10

cefadroxil

Answer 10

1st gen cephalosporin thats also effective against gram + and -

Question 11

Cystitis tx resistance

Answer 11

don't use ampicillin and amoxicillin for uncomplicated cystitis 
Use ertapenem (carbapenem) if resistance suspected

Question 12

pyelonephritis tx, first line

Answer 12

fluoroquinolones (ciprofloxacin, levoflaxacin)

Question 13

fluoroquinolones for pyelonephritis

Answer 13

ciprofloxacin 
levoflaxacin 
administered with broad spectrum abx:
- ceftriaxone 
- gentamicin or tobramycin (aminoglycosides)

Question 14

Aminoglycosides for pyelonephritis

Answer 14

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

Question 15

Pyelonephritis tx, second line

Answer 15

TMP-SMX
oral beta lactams
aztreonam
used in fluoroquinolone hypersensitivity or resistance

Question 16

Aztreonam

Answer 16

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

Question 17

Complicated cystitis tx

Answer 17

ciprofloxacin 
levoflaxacin
- both cover P. aeruginosa 
- both fluoroquinolones 
NOT moxifloxacin

Question 18

complicated pyelonephritis tx, mild

Answer 18

ceftriaxone
ciprofloxacin
levoflaxacin
aztreonam ( monobactam, no beta lactam hypersensitivity )

Question 19

complicated pyelonephritis tx, severe

Answer 19

beta lactam + beta lactamase inhibitor

a carbapenem

Question 20

complicated cystitis caused by gram +

Answer 20

ampicillin or amoxicillin

usually due to E. Faecalis or E. faecium

Question 21

phenazopyridine

Answer 21

urinary analgesic for complicated cystitis

colors urine orange/red

Question 22

beta lactams for first line tx or complicated pyelonephritis

Answer 22

cefepime (4th gen) 
piperacillin ( works against aeruginosa)  + tazobactam 
Ceftolozane (5th gen) + tazobactam 
Ceftazidime (3rd gen)+ avibactam 
meropenem 
imipenem 
doripenem

Question 23

beta lactamase inhibitors

Answer 23

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

Question 24

complicated first line pyelonephritis tx, Carbapenems

Answer 24

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

Question 25

Prostatitis tx

Answer 25

caused by e. coli, proteus or aeuroginosa
tx is trimethoprim-sulfamethoxazole (TMP-SMX)
ciprofloxacin
levoflaxacin

Question 26

Tx for recurrent group A beta hemolytic strep

Answer 26

penicillin G 
cephalexin or cefadroxil 
- 1st gen ceph
Cefpodoxime or cefdinir 
- 3rd gen ceph 
amoxicillin or clindamycin

Question 27

clindamycin

Answer 27

effective against staph, strep or pneumo
enterococci and gram - aerobes resistant 
protein synthesis inhibitor (binds 50s)
risk for C diff 
doesn't reach brain or CSF