UTI's Flashcards
How do elderly patient’s commonly present with UTI’s?
- AMS
- Changes in eating habits
- GI sx’s
How do patient’s with indwelling catheters or neuro disorders commonly present with UTI’s?
- Flank pain
- Fever
- Commonly won’t have lower tract sx’s
What does a Common dipstick test detect?
Presence of nitrites
Causes for a false-negative urine dipstick? (common)
- P.aeruginosa- Do not reduce nitrates
- Dilute urine
- Urinary pH
- Frequent voiding
What does leukocyte esterase dipstick test detect?
pyuria
What is the most reliable diagnostic method for UTI’s?
Urine culture
Uncomplicated UTI treatment
- Trimethoprim-Sulfamethoxazole (Bactrim) x3 days
- One dose of Fosfomycin
- Nitrofurantoin x 5 days
Complicated or suspected Pyelonephritis treatment
Fluoroquinolones x3 days:
- Ciprofloxacin
- Levofloxacin
What is TMP-SMX highly effective against?
Most aerobic enteric bacteria
What is TMP-SMX not effective against?
P. aeruginosa
TMP-SMX ADEs
- Rash
- Steven-Johnson Syndrome
- Photosensitivity
- Renal failure
- Hematologic: Neutropenia, anemia
What is the main advantage of Nitrofurantoin
Lack of resistance even after long courses of therapy
Nitrofurantoin ADE’s
- GI intolerance
- Pulmonary rxns
- Neuropathies
Fosfomycin trometamol ADEs
- Headache
- Angioedema
- Diarrhea
What are the advantages of Fosfomycin trometamol
- Single-dose therapy for uncomplicated infections
2. Low levels of resistance
Who do you need caution use of Fosfomycin trometamol?
Patients with hepatic dysfunction
Fluoroquinolones (Ciprofloxacin and Levofloxacin) ADE’s
- Skin- Hypersensitivity, Photosensitivity
- GI sx’s
- Neuro-Dizzines, Confusoin
- Tendonitis-Black Box warning
What is the main advantage of Fluoroquinolones?
Greater spectrum of activity= + P. aeruginosa coverage
What are Fluoroquinolones effective in treating?
- Pyelonephritis
2. Prostatitis
Who should we avoid treating with Fluoroquinolones?
- Pregnant women
2. Children
What is the preferred treatment for uncomplicated cystitis? Why?
Amoxicillin-Clavulanate (Augmentin)
D/T increasing E. coli resistance
Amoxicillin-Clavulanate (Augmentin) ADE’s
- Hypersensitivity: Rash, anaphylaxis
- Diarrhea
- Superinfection
- Seizure
Cephalosporins (Cefaclor
Cefpodoxime-proxetil) ADE’s
- Hypersensitivity: Rash, anaphylaxis
- Diarrhea
- Superinfection
- Seizure
Disadvantages of Cephalosporins (Cefaclor
Cefpodoxime-proxetil)
- No major advantage of these over other agents
2. Not active against enterococci
Who do need avoid treating with TMP-SMX with?
Avoid in third trimester of pregnancy
Lactobacillus possible advantages
Help keep vaginal pH in normal range to regulate genitourinary bacteria and prevent UT’s
POSSIBLE clinical benefits of cranberry juice
Decreases adherence of bacteria to bladder epithelial cells
Possible clinical benefit in sexually active women w/ recurrent UTI’s
Main benefit of Phenazopyridine HCL
Urinary anesthetic/analegesic- Helps with dysuria
Disadvantage of Phenazopyridine HCL
Mask si/sx’s of UTI’s NOT responding to abx therapy
What is the main SE of Phenazopyridine HCL
Red-orange body fluids, including soft contact lenses
