UTI DOSING Flashcards
Empiric Antibiotics for Uncomplicated Cystitis in Women (IDSA guidelines, 2010)
community acquired
1st line:
•PO co-trimoxazole (S) 800/ (T) 160mg bid x 3d or
•PO nitrofurantoin 100mg bid OR 50mg qid x 5d
Alternatives:
•PO Fosfomycin trometamol 3 gm single dose
•PO fluoroquinolones x 3 days, (BAD)
eg: •PO ciprofloxacin 250mg bid
•PO levofloxacin 250mg daily
•PO beta-lactams x 3-7 days
(normally 7days; not as effective)
eg: •PO cefuroxime 250mg bid
•PO cephalexin 500mg bid
•PO amoxicillin-clavulanate 625mg bid
For complicated cystitis in women, treat for longer duration eg 7 to 14 days. BL=14days
first line CA-UTI (Cystitis in women) empirical
1st line:
•PO co-trimoxazole (S) 800/ (T) 160mg bid x 3d or
•PO nitrofurantoin 100mg bid OR 50mg qid x 5d
For complicated cystitis in women, treat for longer duration eg 7 to 14 days. BL=14days
alternate line CA-UTI (Cystitis in women) empirical
Alternatives:
•PO Fosfomycin trometamol 3 gm single dose
•PO fluoroquinolones x 3 days, (BAD)
eg: •PO ciprofloxacin 250mg bid
•PO levofloxacin 250mg daily
For complicated cystitis in women, treat for longer duration eg 7 to 14 days. BL=14days
BL CA-UTI (Cystitis in women) empirical
•PO beta-lactams x 3-7 days
(normally 7days; not as effective)
eg: •PO cefuroxime 250mg bid
•PO cephalexin 500mg bid
•PO amoxicillin-clavulanate 625mg bid
For complicated cystitis in women, treat for longer duration eg 7 to 14 days. BL=14days
Empiric Antibiotics for Community-acquired Pyelonephritis in women
•First line PO fluoroquinolones
•PO ciprofloxacin 500 mg twice daily x 7 days or
•PO levofloxacin 750 mg daily x 5 days
or
- PO co-trimoxazole 160/800 mg twice daily x 14 days or •PO B-lactam x 10-14 days
- PO cephalexin 500mg bid
- PO amoxicillin-clavulanate 625mg bid-tds
** for severely ill patients who require hospitalisation or are unable to tolerate oral drug, consider initial intravenous (IV) therapy:
-[IV ciprofloxacin 400mg bid or IV cefazolin 1g q8h or
IV amoxi-clav 1.2g q8h] and/or [IV/IM gentamicin
5mg/kg]
then
-Switch to oral when patient improved or able to take orally
Initial empiric therapy should be modified based upon results of urine culture and susceptibility
for severely ill patients who require hospitalisation or are unable to tolerate oral drug, consider initial intravenous (IV) therapy:
Empiric Antibiotics for Community-acquired Pyelonephritis in women
-[IV ciprofloxacin 400mg bid or
IV cefazolin 1g q8h or
IV amoxi-clav 1.2g q8h] and/or [IV/IM gentamicin
5mg/kg]
then
-Switch to oral when patient improved or able to take orally
first line Empiric Antibiotics for Community-acquired Pyelonephritis in women
- First line PO fluoroquinolones
- PO ciprofloxacin 500 mg twice daily x 7 days or
- PO levofloxacin 750 mg daily x 5 days
Alternative Empiric Antibiotics for Community-acquired Pyelonephritis in women
- PO co-trimoxazole 160/800 mg twice daily x 14 days or •PO B-lactam x 10-14 days
- PO cephalexin 500mg bid
- PO amoxicillin-clavulanate 625mg bid-tds
EmpiricAntibiotics for community-acquired UTI in Men
PO ciprofloxacin 500mg twice daily or
PO co-trimoxazole 160/800 mg twice-daily
Choose antibiotics to treat for prostatitis, until prostatitis is ruled out
Treat for 10-14 days, will need longer duration if prostatitis confirmed (6 weeks).
Prostatitis symptoms:
localised pain (perineal, scrotal, pain on ejaculation), voiding difficulties, suprapubic discomfort
digital rectal exam of prostate gland shows tender and enlarged prostate gland
Initial empiric therapy should be modified based upon results of urine culture and susceptibility
Empiric Antibiotics for Nosocomial/ Healthcare associated Pyelonephritis
tx and what is HA-UTI
- Nosocomial – onset of UTI >48h post admission •Healthcare associated -patients who have been hospitalized or underwent invasive urological procedures in the last 6 months, has an indwelling urine catheter, etc
- The possibility of Pseudomonas aeruginosa and other resistant organisms (eg extended beta-lactamase producing E coli and Klebsiella) should be considered and broad-spectrum B-lactam may be used for empiric therapy.
Example:
•IV cefepime 2g q12h +/-IV amikacin 15mg/kg/d or
•IV imipenem 500mg q6h or
•IV meropenem 1g q8h
•Duration of treatment is 7-14 days (afebrile within 3days = 7days)
Initial empiric therapy should be modified based upon results of urine culture and susceptibility
Empiric Antibiotics for Nosocomial/ Healthcare associated Pyelonephritis
- IV cefepime 2g q12h +/-IV amikacin 15mg/kg/d or
- IV imipenem 500mg q6h or
- IV meropenem 1g q8h
•Duration of treatment is 7-14 days (afebrile within 3days = 7days)
Cephalexin dosing
Uncomplicated cystitis:
PO 500mg bd x 3-7d
Pyelonephritis:
PO 500mg-1g bd x 14d
Prophylaxis:
250-500mg/d
cephalexin ADR
and pt counseling
<10% cross-sensitivity for penicillin allergy (avoid if anaphylaxis).
Generally safe in pregnancy ADR: GI
Take without regards to food, if GI discomfort, take with food.
Cotrimoxazole SMZ 800mg/ TMP 1600mg dosing
-Uncomplicated cystitis:
PO 960mg bd x 3d
-Cystitis, men:
PO 960mg bd x 7-14d
-Pyelonephritis:
PO 960mg bd x14d
-Prophylaxis: 240mg daily or 3x/ week
Cotrimoxazole SMZ 800mg/ TMP 1600mg ADR++
Avoid in sulpha allergy, G6PD def,
1st & 3rd trimester pregnancy, CrCl < 15ml/min, folate deficiency.
ADR:nausea, vomiting, myelosuppression, SJS, hyperkalemia, hepatotoxicity, photosensitivity
N/V (take after food), photosensitivity, adequate hydration to prevent crystalluria, Discontinue at first sign of rash.
Ciprofloxacin dosing
-Uncomplicated cystitis:
PO 250mg bd x 3d
-Cystitis, men:
PO 500mg bd x 7-14d
-Pyelonephritis:
PO 500mg bd x 7-14d (7d in women)
-Prophylaxis:
PO 125-250mg/d
cipro ADR ++
Avoid in pregnancy, children, patient with altered cardiac conduction
Caution in pt at risk of seizures.
ADR:tendon inflammation, hypo/hyperglycemia, photosensitivity.
GI upset (take w food).
Administration apart from Ca, Fe.
CNS (headache, dizziness) photosensitivity.
Tendon inflammation (discontinue at first sign of pain, esp in elderly).
Nitrofurantoin dosing
-Uncomplicated cystitis:
PO 50mg qds or 100mg bdx 5d
-Prophylaxis:
PO 50mg daily
Not for pyelonephritis.
Nitrofutation ADR ++
Not for pyelonephritis.
Avoid in renal impaired Crcl < 60ml/min, pregnancy at term (38-42 weeks),
G6PD def
ADR: GI, Pulmonary fibrosis (unexplained malaise, cough, SOB). Tingling extremities (neuropathy) with dose-accumulation.
Take with food (incr absorption, reduce GI upset). Nausea, headache, dark coloured urine
Amoxicillin/ Clavulanate
dosing
Uncomplicated cystitis:
PO 625mg bd x 3-7d
Pyelonephritis:
PO 625mg bd/tds x 10-14d
Amoxicillin/ Clavulanate
ADR ++
Avoid in penicillin allergy, history of hepatic impairment with Augmentin/penicillin.
Generally safe in pregnancy
ADR: cholestatic jaundice, GI esp diarrhea, vaginal mycosis
Take with/ without food. Nausea, vomting, diarrhoea
Fosfomycin dosing
Cystitis:
PO 3g single dose
CA-UTI:
PO 3g EOD x 3 doses (provided no suspicion of pyelo)
Not for pyelonephritis.
Fosfomycin ADR ++
Not for pyelonephritis.
ADR: headache, diarrhoea, vaginitis
Take with/ without food. Headache, diarrhoea
Adjunctive thearpy for UTI
ADR
- Pain and fever –paracetamol or NSAIDs
- Vomiting –rehydration
- Urinary symptoms
- Phenazopyridine (Urogesic®):
- Dose: 100-200mg tds •
an azo dye and exerts a topical analgesic effect on the urinary tract mucosa to provide symptomatic relief
•treatment should be limited for the duration of symptoms
•DO NOT USE IN G6PD deficiency
•ADR: nausea, vomiting, orange-red discolouration of urine and stool
•Urine alkalization (Na/K citrate ; citravescent) : relief discomfort in mild UTI, unproven benefit
Drug regimens for recurrent cystitis
Treat as complicated UTI
for prophylaxis
•cotrimoxazole 200/40 daily or 3X per week •nitrofurantoin 50mg daily
•trimethoprim 100mg daily
•cephalexin 250-500mg daily
•norfloxacin 200mg daily or 3x per week
•ciprofloxacin 125 –250 mg daily
Post-coital prophylaxis
•cotrimoxazole 200/40mg (half of 480mg tablet) •nitrofurantoin 50mg
•trimethoprim 100mg
•cephalexin 250mg
Empiric tx for catheter associated UTI
- IV imipenem 500mg q6H or IV meropenem 1g q8h
- IV cefepime 2g q12H +/-IV amikacin 15mg/kg (1 dose)
- PO/ IV levofloxacin 750mg x 5d (for mild CA-UTI)
- PO Co-trimoxazole 960mg bid x 3d (for women ≤65 years with CA-UTI without upper urinary tract symptoms after an indwelling catheter has been removed)
- Duration of treatment: usually 7 days in those with prompt resolution of symptoms (i.e. deferverse in 72 hrs) and 10–14 days of treatment for those with a delayed response
- Chronic suppressive therapy is not recommended.
