UTI Drugs

Question 1

Antimicrobial agents used for UTIs

Answer 1

1. Trimethoprim-sulfamethoxazole (TMP-SMX)
2. Fosfomycin
3. Nitrofurantoin
4. Cirpofloxacin
5. Levofloxacin
6. Ceftriaxone
7. Amoxicillin-Clavulanate

Question 2

Antifungals used for UTIs

Answer 2

1. Fluconazole

2. Flucytosine

Question 3

Tx of Acute uncomplicated cystitis?

• (In first-line order)
• (assuming non-pregnant)

Answer 3

1. Trimethoprim-Sulfamethoxazole* (TMP-SMX)
2. Nitrofurantoin
3. Fosfomycin (single dose)

*local rates of resistance must be

Question 4

Tx of Acute uncomplicated pyelonephritis?

• (In first-line order)
• (assuming non-pregnant)

Answer 4

1. Ciprofloxacin
2. Levofloxacin
3. Trimethoprim-Sulfamethoxazole (TMP-SMX)
4. Ceftriaxone IV followed by 7-14 days oral antibiotic

Question 5

Tx of outpatient Complicated UTIs? (In first-line order)

Answer 5

1. Ciprofloxin or Levofloxacin
2. Trimethoprim-Sulfamethoxazole (TMP-SMX)
3. Amoxicillin-Clavulanate

Question 6

Tx of hospitalized Complicated UTIs? (In first-line order)

Answer 6

1. Cefepime (4th gen cephalosporin)
2. Ceftriaxone (3th gen cephalosporin)
3. Levofloxacin
4. Ticaracillin-Clavulanate

Question 7

Tx of acute prostatitis? (In first-line order)

Answer 7

1. Ciprofloxin
2. Levofloxin
3. Trimethoprim-Sulfamethoxazole (TMP-SMX)

Question 8

Tx of severe prostatitis? (In first-line order)

Answer 8

Intravenous (IV):

1. Fluroquinolone
2. 3th gen cephalosporins (Ceftriaxone or Ceftazidime)

Question 9

Tx of Reccurent UTIs?

a. Most commonly used (In first-line order)
b. Occasional first-lines (in order)

Answer 9

Most common

1. Nitrofurantoin
2. Trimethoprim-Sulfamethoxazole (TMP-SMX)

Ocassionally:

1. 2nd Gen cephalosporins (Cefector and Cephalexin)
2. Trimethoprim

Question 10

Tx of candiduria?

Answer 10

1. Oral Fluconazole

2. Oral Flucytosine

Question 11

General side effects of oral antimicrobials used to treat UTIs?

Answer 11

1. GI upset
2. N/V
3. Rash
4. Pruritis (itching of skin)

Question 12

Excretions of drugs used to treat UTIs?

Answer 12

All drugs used to treat UTIs are exclusively or extensively excreted in the urine

thereby providing a high drug concentration in the intended site of drug action

Question 13

MOA of TMP-SMX?

Answer 13

Synergistic sequential inhibitors of enzymes involved in bacterial synthesis tetrahydrofolic acid

Question 14

Contraindications for using TMP-SMX?

Answer 14

1. Patients with folate deficiency

2. Pregnancy (Use okay in 2nd Trimester, but probably should still avoid)

Question 15

MOA of Nitrofuratoin

Answer 15

Metabolically activated by bacterial flavoproteins to active intermediates that inactivate or alter bacterial ribosomal proteins

Question 16

Additional AEs of Nitrofuratoin?

Answer 16

1. Loss of appetite (inappetence)

2. Colors urine brown

Question 17

Alternative drug used to tx a UTI in a pregnant women?

Answer 17

Nitrofuratoin

• administered for 5 days
• equally effective as TMP-SMX

Question 18

MOA of Fosfomycin?

Answer 18

Antimetabolite inhibitor of bacterial cytosolic enolpyruvate transferase
- decreases peptidogylcan chain formation

Question 19

Resistance to Fosfomycin develops rapidly

- what are these mechanisms?

Answer 19

1. Mutation in drug target

2. Decreased uptake

Question 20

Significant AEs of Fosfomycin?

Answer 20

1. Peripheral Neuropathy
2. Renal tox
3. Hepto tox
4. Pulmonary tox

• with long-term use
• monitor function!

Question 21

Can Fosfomycin be used safely in pregnancy?

Answer 21

Yes

BUT not with breastfeeding

Question 22

MOA of Fluorquinolones?

Answer 22

Inhibit bacterial topoisomerases (DNA gyrase)

Question 23

Serious AEs of Fluoroquinolones?

Answer 23

1. Tendonitis and Tendon Rupture (worse w/ concurrent steroid use)
2. Chondrogenesis
3. Increased QT interval (Cipro)

Question 24

Length of drug administration for Cipro- and Levofloxacin?

Answer 24

• Ciprofloxacin (7 days)

- Levofloxacin (5 Days)

Question 25

Contraindication for Fluoroquinolones (ciprofloxacin and levofloxacin)?

Answer 25

1. Pregnancy | 2. Children

Question 26

What drugs used to treat UTIs are having issues with resistance?

Answer 26

TMP-SMX and Fluoroquinolones

Question 27

Pregnant women with pyelonephritis. How do you tx?

Answer 27

Single IV dose of a 3rd generation Cephalosporin (ceftriaxone) - in conjunction with short-course oral beta-lactams

Question 28

Serious AEs of Ceftiaxone?

Answer 28

1. Anaphylaxis 2. SJS (stevens-johnson syndrome) 3. Renal failure

Question 29

Effectiveness of Amoxicllin-Clavulanate in treating UTIs compared to fluoroquinolones and TMP-SMX?

Answer 29

Amoxicllin-Clavulanate Less effective

Question 30

Why is fluconazole, and not other Azoles, useful in treating Candiduria?

Answer 30

Only azole to be eliminated renally | - thereby producing high drug concentrations in urinary tract

Question 31

Contraindications of fluconazole?

Answer 31

Pregnancy

Question 32

Tx of flucanazole-resistant cases of candiduria?

Answer 32

Flucytosine (pro-drug for 5-Flurouracil)

Question 33

Adverse effects of Flucytosine

Answer 33

Commonly: Headache, N/V, Hallucinations - Bone marrow suppression w/ long term use

Question 34

Contraindications of Flucytosine?

Answer 34

Pregnancy

Question 35

UTI drugs with contraindications for pregnancy

Answer 35

1. TMP-SMX 2. Fluoroquinolones 3. Flucytosine

Question 36

How would Amphotericin B be given to treat genitourinary fungal infections? Why is this necessary?

Answer 36

Intravesically (directly administered into the bladder via a catheter) - lipid formulation of Amphotericin B prevents the drug from being renally eliminated (renal toxicity)

Question 37

Methods to prevent recurrent UTIs

Answer 37

1. Urinate before and after sex 2. Do not use spermicides 3. Antimicrobial prophylaxis (post-coital use has less AE than daily prohylaxis) 4. non-microbials (Lactobilli and estrogen cream) 5. Cranberry extract (maybe)