UTI Guidelines Flashcards
How common is sporadic cystitis in intact male dogs? What differentials should be considered?
not common
should consider prostatitis
How is sporadic bacterial systitis defined?
less than 3 episodes within last 12 months
What methods of obtaining urine for culture are not recommended?
urinary catheter
free catch
How should a culture be adjusted if voided urine is used?
voided urine –> start culture within hours
and perform quantitative culture
What is the treatment recommendation for sporadic cystitis (type of medications and duration)
- consider giving NSAIDS for 3-4 days and see if self-resolving
- consider waiting for culture results before starting Abx
- if indicative clinical signs, bacteria on sediment, and dog, can give without culture: amoxicillin for 3-5 days
- TMS can be considered but more side effects
Why is clavulanic acid unlikely necessary in sporadic cystitis treated with amoxicillin?
because amoxicillin reaches such high cc, that even beta-lactamase-producing bacteria will be sufficiently inhibited
What is the recommendation for using fluoroquinolones, nitrofurantoin, or 3rd generation cephalosporins in sporadic cystitis?
not recommended unless, culture shows resistance to amoxicillin and TMS and clinical signs have not resolved
When should antibiotics be changed for treatment of sporadic cystitis?
if culture shows resistance AND clinical signs have not resolved
do not need to switch if culture shows resistance but CS are resolving sufficiently
When should you obtain a post-treatment urinalysis or sporadic cystitis?
not needed as long as CS resolve
How does the treatment recommendation for sporadic cystitis differ between dogs and cats?
no empirical abx given to cats due to very low occurence of UTIs
How is recurrent bacterial cystitis defined?
3 or more UTIs within last 12 months
2 or more UTIs within last 6 months
What workup is recommended for patients with recurrent bacterial cystitis?
urinalysis
culture
full workup for complicating factors (i.e., blood work, ultrasound, radiographs)
consider cystoscopy +/- bladder mucosa biopsy for histopath and culture
How should treatment be changed if bacterial cultures shows resistance to the abx tx in recurrent bacterial cystitis patients?
only change treatment if CS are not resolving
if clinical failure documented –> change abx
How should the treatment duration differ between reinfections and persistent/relapsing infections of recurrent bacteria cystitis?
- long term treatment not automatically warranted
- 3-5 days
consider longer treatment if factors like bladder wall invasion present
What is the recommendation for recheck cultures in dogs treated for recurrent bacterial cystitis?
- consider after 5-7 days of treatment
- consider culture after 5-7 days of cessation of abx treatment
What group of bacteria are most pyelonephritis cases caused by?
Enterobacteriacea
Describe the full diagnostic workup recommended for cases of suspected pyelonephritis.
- urine culture (cysto) use MIC for serum not urine!
- cbc/chem
- ultrasound
- consider pyelocentesis - especially if urine culture from cysto negative
- blood culture if febrile
- Lepto PCR and MAT (serology)
What is the recommended empirical treatment for pyelonephritis?
Fluoroquinolones or Cefpodoxime
IV 3rd generation options: Cefotaxime, Ceftazidime
When should IV Abx therapy be considered in pyelonephritis?
if animal does not appear systemically well or in anorexic
IV recommended if dehydrated/lethargy/anorexic or hyporexic
Explain how culture results should be evaluated and how treatment should be adjusted in dogs with pyelonephritis
combination therapy - both susceptible - stop one
combination therapy - one resisitant - stop that one
if not clinical response - add another susceptible abx
both resistant and no clinical response - change abx treatment
if clinical response dont change - unless other reason for improvement (e.g., IV therapy)
What length of abx is recommended for pyelonephritis?
10-14 days
What all should be rechecked 1-2 weeks after cessation of abx tx in pyelonephritis
serum creatinine, physical exam, UA, culture
What drug properties make an antibiotic most likely to penetrate the blood-prostate-barrier?
lipid soluble, weakly alkaline, high pKa
Explain the indication or usefulness of the following drugs for bacterial prostatitis:
* Enrofloxacin
* TMS
* Clindamycin and macrolides
* Ciprofloxacin
* penicillins/cephalosporins/aminoglycosides /tetracyclines
Enrofloxacin - recommended, good penetration, covers suspected common pathogens
TMS - Only trimethoprim (not sulfonamide) has good penetration, but evidence of good clinical response - can be considered
Clindamycin/Macrolides - can penetrate barrier, but lack of efficacy against gram-negative bacteria
Ciprofloxacin - not recommended, unpredictable bioavailability
penicillin/cephalosporins/aminoglycosides/tetracycline - not recommended, not good penetration
What is the recommended antibiotic treatment duration for bacterial prostatitis?
4 weeks for acute
4-6 weeks for chronic
How should a patient be monitored on follow-up for bacterial prostatitis?
prostatic size, rectal palpation, ultrasound
culture not recommended
In dogs with struvites, what is the most common bacteria inducing this?
What is the full chemical name of struvite crystals and how do bacteria cause their formation?
Staphylococcus pseudointermedius
Magnesium ammonium phosphate
urease-forming bacteria - hydrolyze urea to ammonia - used for crystals + increase pH
For bacterial cystitis induced uroliths, how long should abx tx last?
7 days
What is the recommendation for abx tx in uroliths without evidence of bacterial cystitis?
abx rarely indicated
treat as subclinical cystitis
