UTI/Pylelonephritis

Question 1

Urinalysis

Answer 1

-Cloudy
-Alkaline > 8.5
-Protein, nitrite positive
-WBC, RBC, bacteria

Question 2

Pharmacotherapy (Uncomplicated Cystitis)

Answer 2

Non-pregnant, healthy, < 48 hr sx, absence of systemic sx

First-Line Agents
-Nitrofurantoin 100 4x
*macrobid is 100 2x
-TMP/SMX 160/800 2x
-Fosfomycin 3 g 1x

Alternatives
-Fluroquinolones
-B lactase (NOT amp/amox)

Question 3

Fluoroquinolones FDA Warnings

Answer 3

-Tendonitis
-CNS effects
-Peripheral neuropathy
-Glucose balance

Try to avoid if possible unless no other options

AEs: on my Ps and Qs
-Rash, GI (reg, for all)
-QT pro
-Photosensitivity

Question 4

Acute Uncomplicated Cystitis Non-Pharmacologic Therapy

Answer 4

-Aggressive hydration
-Cranberry juice/supp
-Vitamin C

Question 5

Monitoring

Answer 5

-Signs/sx daily
-UA and culture
-AEs

Question 6

Cystitis in Pregnancy

Answer 6

Longer tx 7-14 days

-Cephalosporin
-Amox/Clav
-Sulfonamides (avoid first = birth defects risk)
-Nitrofurantoin (avoid first or near term)

Question 7

Acute Pyelonephritis Pharmacotherapy (Outpatient)

Answer 7

7-14 days

Outpt if mild/mod

If < 10 % resistance: FQ
-Cipro 500 BID + 1 IV dose
-Cipro XR 1000 QD + 1 IV dose
-Levo 750 QD + 1 IV dose

If > 10 % resistance: ACE
-CTRX
-AG
-Ertapenem

*TMP/SMX if bug is susceptible

Question 8

Pyelonephritis Pharmacotherapy Inpatient

Answer 8

-Cipro 400 mg IV q12h
-Levo 500 mg IV q24h
-Gentamicin or Tobramycin with ampicillin
-CTRX 1 g QD
-Zosyn 3.375 g q8h
-Meropenem 500 mg q8h
-TMP/Sulf 160/800 mg q12h

QMZ TATA

*treat with IV until fever goes away, 5-10 days

Question 9

UTI (cystitis) in Men

Answer 9

Treat for 10-14 days (longer), need urine sample

Same antimicrobials at same doses as in female
-Sulf/tri
-Cipro/levo/moxifloxacin

Question 10

Acute/Chronic Prostatitis

Answer 10

Have to penetrate prostate

-Ceftriaxone 1-2 g IV daily with or without gentamicin/tobramycin
-Zosyn 3.375 g IV q8 ex
-Cipro 400 mg IV q12 or levo 500-750 mg qd
-Cipro 500 mg po q12h, levofloxacin 500 or 750 mg po
daily
-Tri/sulf: 1 DS PO q12h
-Doxycycline, amoxicillin/clavulanic acid

TAZ QT

*Chronic 6-12 weeks (Tri/SMX or FQ)

Question 11

UTI Recurrence

Answer 11

3+ in one year, 2+ in 6 months

Suppressive therapy, 6 mo
-TRI/Sulf 1/2 qd or 3x wk
-TRI 100
-Cipro 500
-Levo 250
-Nitro 50-100

Prevention
-Voiding after intercourse
-Good hydration
-Frequent, complete voiding
-Single-dose tri/sulf after intercourse

Question 12

Fungal UTI

Answer 12

High risk pts
-neutropenia, infants, urologic manipulation (fluconazole for procedure)

= Fluconazole x 14 days
-Cystitis 200
-Pyelonephritis 200-400

= Resistance
-Flucytosine (BMS)
-Ampho b
-Ampho deoxy

Question 13

Common AEs

Answer 13

TMP/SMZ
-Sulfa allergy
-GI, crystallization
-Photosensitivity
-Hemolytic anemia

Nitro
-GI, neurotoxicity, pneumonitis

Fosfomycin
-Diarrhea (well tol)

Question 14

Acronyms

Answer 14

CYSTITIS
-uncomp: NBF
-preg: ceph/aug
-men: bac/fq

PYELO
-OP: FQ or ACE
-IP: QMZ TATA

PROST
-TAZ QT

RECUR
-BN QT