UTI's & Bacterial Prostatitis

Question 1

Uncomplicated Cystitis

Answer 1

Requires an otherwise healthy, premenopausal female with no structural or functional abnormalities of the urinary tract

Question 2

Urinary symptoms of a UTI

Answer 2

(not always present)

dysuria and increased frequency

Question 3

Urinalysis indicative of a UTI

Answer 3

Leukocyte esterase, nitrites, bacteria, WBC’s

Question 4

Urine Culture indicative of a UTI

Answer 4

Considered significant if > 10^5 with no symptoms

Counts >100CFU/mL & < 100,000 may be considered significant in the presence of urinary symptoms

Question 5

Systemic signs of infection

Answer 5

• fever
• flank pain
• N/V
• Malaise

Question 6

Treatment for Asymptomatic Bacteriuria

Answer 6

Screening & tx is indicated ONLY for:

• Pregnant women
• Patients w/ planned urologic procedures w/ anticipated bleeding

Question 7

Acute Bacterial Prostatitis Management

Answer 7

• Non-severely ill patients can receive oral therapy for 2-4 weeks (Bactrim DS BID < Cipro 500mg BID, Levaquin 500mg QD)
• severely ill patients may require initial IV therapy (IV Cipro > Bactrim; Broad-spectrum PCNs or cephalosporins are appropriate in critical illness)

Question 8

Chronic Bacterial Prostatitis Management

Answer 8

-4-8 weeks of systemic antibiotics recommended
(FQs > Bactrim)
- May required surgical intervention

Question 9

Pregnant Women

Answer 9

Bacteriuria has significant consequences (pyelonephritis, prematurity, still birth)
- avoid FQs & doxy, Caution w/ macrobid, and avoid Bactrim after 32 weeks gestation

Question 10

Patients w/ indwelling catheters

Answer 10

• Remove short-term catheters if possible upon discovery of bacteriuria
• bacteriuria is inevitable w/ long-term catheterization
• initiate antimicrobial therapy if symptoms occur
• prophylactic antibiotics are NOT recommended

Question 11

Patient’s w/ frequently recurring UTIs (3 or more episodes/yr)

Answer 11

• self- administered short course therapy (initiate w onset of sxs)
• Low dose continuous therapy (avoid if possible due to resistance) –> trimethoprim 100mg QD or Marobid 50-100mg QD

Question 12

Nitrofurantoin (Macrobid)

Answer 12

• 1st line tx in uncomplicated cystitis (DOC)
• 100mg BID x 5-7 days
• Contraindicatedif CrCl < 60ml/min
• Not effective in pyelonephritis (duh)
• Ensure correct dosage form – Macrodantin = QID; Macrobid = BID

Question 13

Bactrim DS

Answer 13

• 1st line tx in uncomplicated cystitis
• 800/160mg x 3 days
• assess for hx of sulfa allergies
• Decrease dose to 1/2 if CrCl 15-30ml/min
• Contraindicated if CrCl < 15ml/min

Question 14

Fosfomycin (Monurol)

Answer 14

• 1st line tx in uncomplicated cystitis
• 3g x 1 dose
• Powder mixed w/ water prior to administration
• no renal or hepatic dose adjustments
• not quite as effective as our other first line options

Question 15

FQs for treating uncomplicated cystitis

Answer 15

• alternative tx
• Levaquin 250mg QD x 3 days; Cipro 250mg BID x 3 days
• not recommended 1st line due to increasing resistance & ADEs
• reserve for serious or complicated infections (pyelonephritis; prostatitis)

Question 16

Beta-lactams for treating uncomplicated cystitis

Answer 16

• alternative tx
• courses of 7-10 days w/ close follow-up to ensure clinical improvement
• generally less effective for UTI’s than others
• Only use if 1st line options are not feasible
• Avoid amoxil alone ( use augmentin) –> most E. coli produce beta-lactamases

Question 17

Initial therapy for Uncomplicated pyelonephritis

Answer 17

• Initial dose of a parenteral antibiotic is recommended
• Ceftriaxone 1g or 5-7mg/kg tobramycin/gentamicin (24 hr dose)
• Max conc. of ceftriaxone for IM use is 350mg/ml ( up to 5mls can be given in 1 site, but multiple sites may decrease discomfort)

Question 18

Treatment of uncomplicated pyelonephritis in non-hospitalized patients

Answer 18

• Oral FQs x 7 days (Cipro 500mg BID [can substitute IV dose w/ Cipro 400mg IV once]; Levaquin 750mg QD)
• Oral Bactrim DS BID x 14 days
• Oral Beta-lactams are less effective for pyelonephritis (must use a parenteral initial dose & treat for 10-14 days)

Question 19

Treatment of uncomplicated pyelonephritis in hospitalized patients

Answer 19

• Definitive therapy guided by susceptibility tests
• FQs
• Aminoglycoside +/- ampicillin
• Extended spectrum PCN/Cephalosporin +/- aminoglycosides
• Carbapenems –> reserved strictly for urosepsis