UTI's

Question 1

UTI’s are most common in….

Answer 1

common in females- especially of child-bearing age

Question 2

UTI”s are classified as….

Answer 2

Classified as upper and lower UTI
Lower UTI- infection of the bladder (cystitis)
Upper UTI- infection involving the kidneys (pyelonephritis)  Any tissue at all
Also classified as uncomplicated or complicated

Question 3

Uncomplicated Charcteristics

Answer 3

No structural or functional abnormalities
Premenopausal females of childbearing age (15 – 45 years), otherwise normal and healthy

Question 4

Complicated

Answer 4

Predisposing lesion of the urinary tract- congenital abnormality or distortion of urinary tract, stone, indwelling catheter, prostatic hypertrophy, obstruction or neurological deficit that interferes with normal urinary flow
All UTI in males considered complicated
Most children with recurrent UTI should be investigated for urinary tract abnormality

Question 5

Pathogenesis

Answer 5

Usually develops by ascending route
Colonization of vaginal vestibule followed by colonization of urethra
Sexual intercourse is a major determinant for bacterial entry into bladder for some women
Bacteria enter urine, multiply and cause bladder infection
Bacteria may spread up ureters to kidney especially if there is vesicoureteral reflux or reduced urethral peristalsis
Haematogenous (through blood stream) – rare e.g. Staph. aureus, Enterococci

Question 6

Risk Factors

Answer 6

Age (most common: mainly child bearing aged women)
Gender
Pregnancy
Use of Spermicides and diaphragms (suggest to use other forms of contraception)
Instrumentation of urinary system
Urinary tract obstruction- including drugs like anticholinergics (cause urinary retention)
Incomplete bladder emptying
Neurologic dysfunction – stroke, diabetes, spinal cord injury
Vesicoureteral reflux
Renal disease

Question 7

Common Organisms

Answer 7

S. pneumoniae
S. aureus
E. coli
Enterococcus species
Pseudomonas aeruginosa

Question 8

Uncomplicated UTI Main Organims

Answer 8

E. Coli

Question 9

Complicated Organisms

Answer 9

(E. coli 50%), but more varied ( Enterobacter spp.,Pseudomonas aeruginosa, Staph aureus) and may be more resistant

Question 10

Are urine cultures accurate?

Answer 10

• Often NO

Question 11

Lower UTI Clinical Presentation

Answer 11

dysuria (painful urination), urgency (cannot hold bladder), frequency (more frequent than normal)

• maybe hematuria and suprapubic pain

Question 12

Upper UTI symptoms

Answer 12

flank pain (lower side of ribs), fever, nausea, vomiting, malaise, costovertebral tenderness (cannot prescribe)

Question 13

Uncomplicated TX First Line

Answer 13

TMP/SMX 1 DS bid x 3 days (not a wrong choice)
TMP 100mg bid or 200mg daily x 3 days (if sulfa allergy)
Nitrofurantoin* 50 -100mg QID or Macrobid 100mg BID x 5 days

Question 14

Second Line

Answer 14

Amoxi- Clav –> 500/125 mg BID or 875/125 mg TID for 3-7 days

Norfloxacin 400 mg bid x 3 days
Ciprofloxacin 250mg bid or 500mg ER once daily x 3 days

Question 15

Recurrent UTI

Answer 15

2 uncomplicated UTI within 6 months or three or more positive urine cultures in prior 12 months

Question 16

Reinfection Definition

Answer 16

Occurs after 2 weeks(medSask guidelies use 4 weeks) of completing abx therapy

Caused by a different organism*

Question 17

Relapse Define

Answer 17

Occurs within 2 weeks (2-4weeks) of completing abx tx
Caused by original organism

Question 18

Recurrence TX

Answer 18

Culture
Re-assess for upper tract infection
Re-treat for 7 to 14 days
Same antibiotic choices, however tailor based on C&S

Question 19

Non-antibitic Tx

Answer 19

• Cranberry Juice - not effective; maybe prevantative
• Topical(vaginal) estrogen  effective in post-menopausal woman  will not benefit woman who are already on hormonal tx already

Question 20

Pharmacists can prescribe when….

Answer 20

Not first episode
Not pregnant
Has to be uncomplicated
Cannot be a relapse  can be a recurrent infection

Question 21

UTI in MEN

Answer 21

• Complicated UTI
• Uncommon
• Same drugs as women
• Traditionally tx for 2 weeks
• Now –> 7 days TMP/SMX or cirpofloxacin as effective

Question 22

Pyelonephritis Non-obstructive, mild Tx

Answer 22

TMP/SMX (14d), TMP (14d), norfloxacin, ciprofloxacin(7d), levofloxacin(5d), amoxicillin/clavulanate (10 – 14d)

Question 23

Polynephritis Non-obstructive, sevre

Answer 23

Gentamicin 4-7 mg/kg q 24 h + ampicillin 1 -2 g q 4-6h (IV) (covers all organisms)
Ciprofloxacin 400mg IV q 12 h
Levofloxacin 250-500mg q 24h
-

• Ceftriaxone 1-2g IV q24h (or cefotaxime)+ gentamicin (septic shock, very ill)

Question 24

Bacterial Prostatitis Organims and Diagnosis

Answer 24

E. coli 75%
Other gram negative organisms – K. pneumoniae, P. mirabilis, less frequently P. aeruginosa, Enterobacter spp., Serratia spp.
-
Urine culture
In chronic prostatitis – quantitative localization culture

Question 25

Bacetrial prostatis is…

Answer 25

Inflammation of the prostate gland and surrounding tissue due to infection
Reflux of infected urine into prostate gland

Question 26

Acute Prostatis Sx

Answer 26

fever, chills, tenderness/pain, malaise, myalgia, frequency, urgency, nocturia and retention

Question 27

Chronic Prostatitis SX

Answer 27

urinating difficulty, low back pain, perineal and suprapubic pressure

Question 28

TX of Bacterial Prostatis ACute

Answer 28

Acute – antibiotics penetrate prostate due to acute inflammatory reaction that alters cellular membrane and permeability
TMP/SMX, TMP, norfloxacin, levofloxacin , ciprofloxacin
Severe cases – ampicillin or ceftriaxone IV PLUS gentamicin or tobramycin or amikacin

Total duration minimum 2 weeks; total course should be 4 weeks to prevent chronic infection

Question 29

Tx Chronic Prostatitis

Answer 29

4 – 12 weeks
Fluoroquinolones have better cure rate than TMP/SMX
More difficult to get antibiotic penetration into prostate

Question 30

Pregnancy UTI

Answer 30

Routine screening at 12-16 weeks or first prenatal visit and at 28 weeks
If positive treat for 3-7 days and follow-up culture to document eradication (do a follow up culture)
If untreated -prematurity, low birth weight and stillbirth

Question 31

UTI Preganancy First Line

Answer 31

Cephalexin 250-500mg QID x 7 days
Amoxicillin 500mg tid x 7 days
Nitrofurantoin 100mg bid x 5 days
Avoid at term (36-42 weeks gestation and during labor and in neonates) –> can cause hemolytic anemia in neonate

Question 32

UTI Pregnancy Second Line

Answer 32

TMP/SMX or TMP - avoid in first trimester and in last 6 weeks of pregnancy
(Inhibits folic acid synthesis, important for neural tube defects)