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Antibiotic > UTI DOSING > Flashcards

UTI DOSING Flashcards

1
Q

Empiric Antibiotics for Uncomplicated Cystitis in Women (IDSA guidelines, 2010)

community acquired

A

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

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2
Q

first line CA-UTI (Cystitis in women) empirical

A

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

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3
Q

alternate line CA-UTI (Cystitis in women) empirical

A

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

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4
Q

BL CA-UTI (Cystitis in women) empirical

A

•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

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5
Q

Empiric Antibiotics for Community-acquired Pyelonephritis in women

A

•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

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6
Q

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

A

-[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

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7
Q

first line Empiric Antibiotics for Community-acquired Pyelonephritis in women

A
  • First line PO fluoroquinolones
  • PO ciprofloxacin 500 mg twice daily x 7 days or
  • PO levofloxacin 750 mg daily x 5 days
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8
Q

Alternative Empiric Antibiotics for Community-acquired Pyelonephritis in women

A
  • 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
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9
Q

EmpiricAntibiotics for community-acquired UTI in Men

A

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

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10
Q

Empiric Antibiotics for Nosocomial/ Healthcare associated Pyelonephritis

tx and what is HA-UTI

A
  • 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

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11
Q

Empiric Antibiotics for Nosocomial/ Healthcare associated Pyelonephritis

A
  • 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)

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12
Q

Cephalexin dosing

A

Uncomplicated cystitis:
PO 500mg bd x 3-7d

Pyelonephritis:
PO 500mg-1g bd x 14d

Prophylaxis:
250-500mg/d

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13
Q

cephalexin ADR

and pt counseling

A

<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.

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14
Q

Cotrimoxazole SMZ 800mg/ TMP 1600mg dosing

A

-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

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15
Q

Cotrimoxazole SMZ 800mg/ TMP 1600mg ADR++

A

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.

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16
Q

Ciprofloxacin dosing

A

-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

17
Q

cipro ADR ++

A

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).

18
Q

Nitrofurantoin dosing

A

-Uncomplicated cystitis:
PO 50mg qds or 100mg bdx 5d

-Prophylaxis:
PO 50mg daily

Not for pyelonephritis.

19
Q

Nitrofutation ADR ++

A

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

20
Q

Amoxicillin/ Clavulanate

dosing

A

Uncomplicated cystitis:
PO 625mg bd x 3-7d

Pyelonephritis:
PO 625mg bd/tds x 10-14d

21
Q

Amoxicillin/ Clavulanate

ADR ++

A

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

22
Q

Fosfomycin dosing

A

Cystitis:
PO 3g single dose

CA-UTI:
PO 3g EOD x 3 doses (provided no suspicion of pyelo)

Not for pyelonephritis.

23
Q

Fosfomycin ADR ++

A

Not for pyelonephritis.
ADR: headache, diarrhoea, vaginitis

Take with/ without food. Headache, diarrhoea

24
Q

Adjunctive thearpy for UTI

ADR

A
  • 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

25
Q

Drug regimens for recurrent cystitis

A

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

26
Q

Empiric tx for catheter associated UTI

A
  • 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.

Antibiotic (21 decks)

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